Why A Check-Up On Your Home Health Compliance Plan Is A Good Idea
The following article was written by Lani M. Dornfeld, Esq., a member of the Health Law Practice Group of Brach Eichler L.L.C., based in Roseland, New Jersey
In January, the Centers for Medicare & Medicaid Services (CMS) announced a second wave of temporary moratoria in certain geographic regions on the enrollment of home health agencies in the Medicare Program, Medicaid Program and Children’s Health Insurance Program, with the first wave announced last July. Utilizing its authority under the health reform law, CMS announced it is putting “fraudsters on notice” that it will use all available tools to combat fraud, waste, and abuse in these federal health care programs. CMS stated that, rather than continuing its historical method of “pay and chase,” it is choosing a more preemptive approach to prevent fraud and abuse in certain high-risk areas, including home health.
Consistent with CMS’s preemptive approach, under the health reform law, home health agencies across the nation will also be required to take a preemptive approach to preventing fraud, waste, and abuse through the adoption and implementation of compliance and ethics programs. Although such programs have historically been voluntary, nursing facilities are now mandated to establish them, and we are awaiting final regulations imposing the mandate on “all other providers/suppliers,” including home health agencies. If particular home health agencies have not already adopted a compliance and ethics program, the health reform law should provide them with the impetus to do so immediately by setting forth increased civil and monetary penalties, stiffer federal sentencing guidelines, monetary and other penalties, False Claims Act liability for unreturned overpayments, and recapture of federal funds.