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News recently broke in Virginia of a human service agency employee that was sentenced to ten months in prison for altering client records in order to cover up Medicaid fraud. You can find the article here. Over a three year period, under the direction of the owner, the agency billed for and received reimbursements for 900 fake claims for providing respite services to 30 clients. In total, the agency received over $630,000 of fraudulent Medicaid money. Staff were told to falsify and make false entries to time sheets and office records to make it seem as though respite service had occured when, indeed it had not. Ultimately, the case was investigated at the highest level - the FBI - and the Virginia State Attorney General's Office. The employee has been charged with health care fraud, alteration of records and aggravated identity theft.
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Tags: Compliance, Provider Agencies, Medicaid
For any provider agency operating with Medicaid funds, being aware and in compliance with all of the state and federal regulations is a must. Compliance is so important in this industry and we at MediSked don't take it lightly. But whether or not you are using an Agency Management Platform to manage your compliance initiatives, it's important to know what auditors are looking for. According to The Center for Medicare and Medicaid Services (www.cms.gov), there are six centers and nine offices across the country that provide program management for all areas. One of the centers is the Center for Program Integrity and is the main center for prevention and detection of all national and state-wide fraud and abuse issues for Medicaid. Last February, CPI reorganized into five groups to better target program integrity policies. Below is a brief description of those five groups. If you would like the full report on this, please
click here.
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Tags: Compliance, CMS
The Office of Inspector General (
http://oig.hhs.gov) just released an audit report of Personal Care Services in the State of West Virginia.? Over a 2 year audit period, they looked at 100 beneficiary months and of those 18 were found to have a claim or claims that did not meet federal requirements.
In total, the audit report recommends that the State agency:
To view the full report, click here.
The two main deficiencies laid out in this report are Services Not Supported by Documentation and Services Not In Accordance with Plan of Care.? If agencies are still utilizing paper based methods to document services and plans of care, they run a real risk of incurring these types of deficiencies.
Everyone knows that auditors are looking very carefully for misuse of Medicaid dollars.? Human error is a fact of life when agencies put their faith in paper, binders and non-electronic sources.
For a free report on the most common audit issues for home health and human service provider agencies, click here.? Agencies Management Platforms, such as MediSked Connect, remove human error and eliminate the common audit issues, including the deficiencies listed in this report.
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In total, the audit report recommends that the State agency:
- Refund $360,539 to the Federal Government and
- Improve its monitoring of providers to ensure compliance with Federal and State requirements for personal care services.
To view the full report, click here.
The two main deficiencies laid out in this report are Services Not Supported by Documentation and Services Not In Accordance with Plan of Care.? If agencies are still utilizing paper based methods to document services and plans of care, they run a real risk of incurring these types of deficiencies.
Everyone knows that auditors are looking very carefully for misuse of Medicaid dollars.? Human error is a fact of life when agencies put their faith in paper, binders and non-electronic sources.
For a free report on the most common audit issues for home health and human service provider agencies, click here.? Agencies Management Platforms, such as MediSked Connect, remove human error and eliminate the common audit issues, including the deficiencies listed in this report.
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Tags: Compliance, Medicaid, Waiver Services
