Abstract
The government's focus on health care fraud has been felt strongly in the home care industry. Several antifraud initiatives have targeted home health agencies, hospices, and durable medical equipment suppliers. The assault is expected to continue. Providers must be aware of their regulatory environment and their vulnerabilities and must prepare to defend themselves in the event of an audit or investigation. Awareness of new laws and regulations that change the rules or magnify the penalties for noncompliance can be crucial.
Keywords
Get full access to this article
View all access options for this article.
References
1.
1. US Department of Justice. Department of Justice Health Care Fraud Report. FY 1995-1996, p. 2.
2.
2. U.S. Reaps Millions Battling Health Care Fraud, 14 Medical Benefits 5, October 15, 1997.
3.
3. 42 CFR 484.
4.
4. 42 CFR 418.
5.
5. 62 Federal Register 1005 (March 10, 1997).
6.
6. 62 Federal Register 57458, 57532 (October 29, 1997).
7.
7. 42 CFR 489.10.
8.
8. 42 CFR 489.20 et seq.
9.
9. 42 CFR 424.7(c).
10.
10. Pub L No 103-432, October 31, 1994.
11.
11. 62 Federal Register 57001, 57053 (October 29, 1997).
12.
12. 42 USC 1395x(v)(1)(A); 42 CFR 413.
13.
13. Pub L No 105-33, August 5, 1997.
14.
14. 42 CFR 409.40 et seq.
15.
15. 42 CFR 440.70.
16.
16. 42 CFR 440.170(f).
17.
17. 42 CFR 440.180 and 440.190.
18.
18. 42 CFR 409.42.
19.
19. 42 CFR 409.43(c).
20.
20. 42 CFR 409.43(d).
21.
21. 42 USC 1395nn.
22.
22. 41 CFR 418.301 et seq.
23.
23. 42 CFR 418.20.
24.
24. 42 USC 1396a(a)(13)(D).
25.
25. 42 USC 1395(n).
26.
26. 42 CFR 405.231(g).
27.
27. Medicare Carriers Manual. HCFA Publication 14.
28.
28. 42 CFR 414.200 et seq.
29.
29. “OIG Special Fraud Alert: Home Health Fraud, ” 60 Federal Register 40847 (August 10, 1995).
30.
30. Pub L No 104-191, August 21, 1996.
31.
31. 18 USC 1347.
32.
32. 43 USC 1320a-7b(a).
33.
33. 18 USC 1347.
34.
34. 18 USC 1341, 1343, 1345.
35.
35. 18 USC 1035.
36.
36. 42 USC 1320a-7b(b).
37.
37. 42 USC 1320a-7a.
38.
38. 42 USC 1320a-7(a)(b).
39.
39. 62 Federal Register 47182 (September 8, 1997).
40.
40. 42 CFR 405.370 et seq.
41.
41. 55 Pa Code 1101.73.
42.
42. 42 USC 1395nn.
43.
43. 31 USC 3729 et seq.
44.
44. 31 USC 3730(b).
45.
45. 18 USC 3486.
46.
46. US Sentencing Commission. Guidelines Manual. 1997.
47.
47. OIG Press Office. HHS Fact Sheet, Operation Restore Trust Accomplishments. May 20, 1997.
48.
48. US Attorney Northern District of Illinois. “U.S. Indicts and Sues Former Hospice Operation in Alleged $28 million Fraud Involving Operation and Sale of Hospice.” Press release, October 14, 1997.
49.
49. “Home Health: Problem Providers and Their Impact on Medicare.” OIG study OEI-09-96-00110. July 1997.
50.
50. “Results of the Operation Restore Trust Audit of Medicare Home Health Services in California, Illinois, New York and Texas.” OIG study A-04-96-02121. July 28, 1997.
51.
51. S. 2031, 105th Cong. (1998).