“Hot” Fraud and Abuse Issues under the Prospective Payment System

Abstract

The home care industry has come under frequent scrutiny for violations of fraud and abuse prohibitions. Under cost-based reimbursement, agencies were often scrutinized for filing false cost reports for overutilization. Fraud and Abuse Compliance is not a fad. It has become a permanent part of the health care industry. Although the focus may have changed for home health agencies under the prospective payment system (PPS), the importance of compliance cannot be overemphasized. Under PPS, providers must still be wary of fraud in relation to cost reports. They must also, however, focus on new issues of fraud and abuse, including underutilization, patient dumping, and abandonment. The purpose of this article is to assist providers to focus on fraud and abuse compliance efforts under PPS.