5 Steps for Preventing Healthcare Fraud and Abuse at Hospice and Homecare Agencies
None of us want to think that someone we hire would commit fraud or abuse. However, fraud and abuse in home health and hospice is on the rise. With all the details that owners and managers must contend with, no one needs to add this to their list! Fortunately for us, a nurse colleague of mine, Linda Vincent, R.N., P.I., is in the business of helping businesses like ours put policies in place to help prevent
fraud and abuse. We are fortunate to have her as a guest writer this week. I am sure you will find Linda’s article informative and helpful.
Providing quality care and comfort to patients is the primary concern of hospice and homecare agencies. Unfortunately, it’s not the only one. Owners also need to be proactive and vigilant to ensure they are preventing healthcare fraud and abuse.
Whether the fraud is an accident due to negligence or a scam carried out by an unscrupulous employee, hospice and homecare owners must take precautions to legally and financially protect their businesses. The process of safeguarding themselves, their agencies, and their patients begins and ends with their employees. From nurses to accountants to receptionists, healthcare fraud and abuse can be carried out by anyone at any level of the organization.
Here are five steps hospice and homecare agencies can take today to start preventing healthcare fraud and abuse:
1. Implement internal controls: A hospice or homecare agency cannot operate effectively without a defined set of internal controls that ensure compliance with laws and regulations, accurate financial reports, asset protection, and other measures. Essential healthcare fraud and abuse policies and procedures include defining access and authorization controls, as well as separating duties to reduce opportunities for fraud to occur.
2. Hire honest people: This should go without saying, but it can’t be said often enough. When there’s a shortage of quality caregivers and an increase in patients, it’s easier to rely on trust rather than facts. Unfortunately, trust or a “gut feeling” isn’t enough in the hiring process, especially when a hospice or homecare agency can be bankrupted by just one scam artist. Preventing healthcare fraud and abuse therefore must include background checks on all employees. This includes:
• Employment verification of companies, positions, performance, length of employment, and reasons for leaving
• Education verification, including trainings and accreditations
• Checking criminal and civil records for fraud and other crimes
3. Educate employees: Hospice and homecare owners must inform employees about their policies and procedures for preventing healthcare fraud and abuse, including the internal controls in place and the consequences of violating them. Employees should sign a form to confirm their receipt of this material, and should undergo regular training on topics related to healthcare fraud. A healthcare fraud and abuse expert can provide a “Lunch and Learn” presentation to educate employees on the threats of fraud and what they can do to prevent it.
4. Institute an employee hotline: A confidential system for employees, vendors, patients, and family members to anonymously report suspicious activity is a simple but effective way to prevent healthcare fraud and abuse.
5. Perform audits: Hospice and homecare agencies should receive annual audits of their financials and operations. Agencies should also conduct random, unannounced audits and fraud assessments to discover vulnerabilities. Random audits also let employees know that preventing healthcare fraud and abuse is a high priority.
These are just a few of the ways a hospice or homecare agency can safeguard itself from the devastating ramifications of fraud. To learn more about how to protect your hospice or homecare agency, and to prevent healthcare fraud and abuse, schedule a “Lunch and Learn” by visiting www.theidentityadvocate.com or calling 310.831.4400.
Linda Vincent, R.N., P.I., is an identity theft and healthcare fraud prevention expert specializing in medical consulting and investigations. She teaches corporations, professional practices, and consumers how to stop identity theft and healthcare fraud. Call The Identity Advocate at 310.831.4400 or email info@theidentityadvocate.com. Visit www.TheIdentityAdvocate.com.
Category: Articles, Guest Article
“Hospice and homecare agencies should receive annual audits of their financials and operations.”
A “Real” audit, which must be conducted by a CPA firm, costs tens of thousands of dollars. That is very costly for smaller, family-owned businesses. If the owners are personally involved with the accounting activities of the business, this is not necessary.