April has proved a successful month for the Department of Justice (DOJ). The agency has already had two successful prosecutions against local leaders in the Home Health Care industry accused of health care fraud crimes.
The United States Department of Justice (DOJ) recently charged two individuals who worked with a mental health company with health care fraud and tax evasion. The DOJ has accused the two of diverting millions from the mental health agency into business bank accounts. The government alleges the individuals used the funds in these bank accounts to cover various personal expenses.
The Department of Health and Human Services Centers for Medicare and Medicaid Services (CMS) recently announced it will extend a statewide, temporary moratorium on enrollment of new non-emergency ambulance providers and home health agencies in Texas. The agency intends the freeze to cut down on the risk of fraud, waste and abuse within the system.
The Office of Inspector General (OIG) has named a former Texas health care company owner as one of its “most wanted.” The agency indicted the business owner on various criminal charges related to health care fraud, including conspiracy to pay kickbacks and money laundering.
The Medicare Access and CHIP Reauthorization Act (MACRA) of 2015 mandates removal of Social Security Number (SSN)-based HIC numbers from Medicare cards to address current risk of beneficiary medical identity theft. CMS will use a new MBI generator to assign over 150 Million MBIs beginning April 1, 2018, and continuing through December 31, 2019, for full implementation January 1, 2020. While CMS will continue to process transactions utilizing a beneficiary's current HIC number during the transition period, Medicare fee for service entities must modify their current processes and systems to be ready to submit or exchange the MBI by April 1, 2018. The current system requires a 9-byte SSN plus 1 or 2-byte BIC. The MBI system will require an 11-byte alpha numeric numeration system. All Medicare fee for services entities are advised to check all of their internal billing systems to be certain the software they are currently using will accommodate the new MBIs. During the transition period, Medicare entities will be allowed to enter either the MBI or HIC number. If you use vendors to bill Medicare, ask them about their MBI practice management system changes and make sure they are ready for the change.
A federal grand jury recently indicted a married couple that runs an in-home health care company. Prosecutors allege that the couple and their company defrauded Medicare.
A home health care agency that receives government reimbursement for services provided must have a compliance program in place, and the business owner or Compliance Officer should be responsible for implementing this program.
A 52-year-old Texas woman was recently sentenced to serve 10 years in a federal prison and ordered to pay more than $23 million in restitution to Medicaid and Medicare. The FBI said the sentence was the last to be handed down in "a massive health care fraud case" run by Dr. Jacques Roy.
With hurricanes Harvey and Irma recently wreaking havoc in Texas and the southern United States, the necessity of a disaster response plan for any business has become clear. Pharmacies, home health agencies and other medically based businesses have a few additional elements to consider when it comes to disaster response.
Many regular readers of our Austin blog are familiar with Waxahachie. The small city is a nearly three-hour drive north of us, not far from Dallas.