Home Health Agency Compliance

Home health agencies and certifying physicians need to make compliance a top priority. Federal authorities are focused on the home health care industry, and compliance failures can trigger audits, investigations, and substantial penalties.

All health care providers that bill Medicare, Medicaid, and other government programs are subject to heavy oversight and strict enforcement. Home health care is no exception. In fact, in recent years, a number of high-profile cases of home health care fraud have made the sector a top federal law enforcement priority. While the risks facing home health agencies and certifying physicians today are severe, they can also be effectively managed with a focus on compliance.

Federal Health Care Fraud Lawyers and Consultants Focused on Home Health Compliance 

At Oberheiden, P.C., our home health care compliance team is comprised of experienced attorneys and health care industry professionals who offer centuries of combined experience in the federal health care fraud arena. Several of our attorneys previously served as senior prosecutors with the U.S. Department of Justice (DOJ), the U.S. Attorney’s Office, and the Medicare Fraud Strike Force. Our consultants and auditors understand the issues facing home health agencies and certifying physicians from all angles, and all members of our team are devoted to utilizing compliance procedures and documentation to keep our clients’ practices (and their personal freedom) secure.

What Does Home Health Care Compliance Require?

What does it take for a home health agency to be legally-compliant? How can certifying physicians avoid exposing themselves to the risk of federal prosecution? These are important questions; and, in today’s world, they are becoming increasingly difficult to answer. But, by remaining focused on the issues affecting our health care clients, our lawyers and consultants have developed a comprehensive understanding of what it takes for home health agencies and physicians to avoid raising red flags for federal auditors and agents. With your help, we can make your practice compliant, and we can ensure that you will have a rock-solid defense in the event of an audit or investigation.

Can you confidently answer each of these questions in the affirmative? If not, your home health agency’s or medical practice’s compliance program is not as effective as it could be:

Put our highly experienced team on your side

Dr. Nick Oberheiden
Dr. Nick Oberheiden

Attorney-at-Law & Founder

Amanda Marshall
Amanda Marshall

Former U.S. Attorney

Local Counsel

Lynette S. Byrd
Lynette S. Byrd

Former Federal Prosecutor

Partner

Aaron L. Wiley
Aaron L. Wiley

Former Federal Prosecutor

Local Counsel

Subodh Chandra
Subodh Chandra

Former Federal Prosecutor

Local Counsel

Elizabeth K. Stepp
Elizabeth K. Stepp

Partner

Roger Bach
Roger Bach
(Non-Lawyer)

Former Special Agent, OIG

Dennis A. Wichern
Dennis A. Wichern
(Non-Lawyer)

Former Special Agent-in-Charge

Chris Quick
Chris Quick
(Non-Lawyer)

Former Special Agent, FBI

Kevin M. Sheridan
Kevin M. Sheridan
(Non-Lawyer)

Retired Supervisory Special Agent, FBI

Ray Yuen
Ray Yuen
(Non-Lawyer)

Former Supervisory Special Agent, FBI

Gamal Abdel-Hafiz
Gamal Abdel-Hafiz
(Non-Lawyer)

Former Supervisory Special Agent, FBI

  • Are all of your in-house personnel properly classified as employees? 
  • If you employ any independent contractors, is their compensation structure compliant with the Anti-Kickback Statute?
  • Have you adequately vetted your marketing agency and any firms that supply you with Medicare or Medicaid leads? Do your marketing contracts provide adequate protection against ultimate health care fraud liability?
  • Does your billing compliance program reflect the current standards for Medicare, Medicaid, Tricare, and the U.S. Department of Labor (DOL) billing compliance?
  • If you utilize a third-party billing administrator, is your relationship structured to adequately ensure compliance and provide protection in the event of an inadvertent billing violation?
  • Do you have policies in place to document your agency’s or practice’s compliance with regard to home health-specific issues such as certifications and recertifications, physician supervision, in-person examinations, and adhering to patients’ care plans?
  • Are you prepared to appropriately (and safely) self-report billing violations if necessary?
  • Do you have a system in place to ensure that your compliance program gets updated when federal rules and regulations change?
  • Do you have a system in place to promote internal reporting of violations and promptly address any identified compliance issues?
  • Do all of your personnel understand their individual role in ensuring that you consistently maintain a compliant home health care practice?

If you answered, “No,” or “I don’t know,” to even one of these questions, then you could benefit from speaking with a member of our compliance team. Whether you need to make minor adjustments to your practice’s existing compliance program or it is time for a complete compliance overhaul, we will provide you with honest, straightforward advice so that you can decide what you need to do in order to feel confident billing Medicare, Medicaid, Tricare, and/or the DOL.

10 Free Compliance Resources for Home Health Agencies and Certifying Physicians 

In many respects, compliance is about education. Until you have a clear and comprehensive understanding of your home health agency’s or medical practice’s obligations, the reality is that you simply have no way of knowing whether or not your current compliance efforts are sufficient. To learn more about what it takes to avoid scrutiny as a home health care provider that bills Medicare, Medicaid, Tricare, or the DOL, we encourage you to read:

  • The Federal Government Is Finding New, Aggressive Ways to Combat Home Health Fraud – From joint task forces to undercover informants, when it comes to targeting home health care agencies and certifying physicians for billing fraud, the federal government is currently pulling out all of the stops. Access to new technology has made it easier for federal authorities to identify home health agencies and physicians to target in audits and investigations as well. 
  • Home Health Fraud – Common Characteristics – While every home health agency is unique (and its compliance program must be drafted accordingly), most audits and investigations targeting these agencies focus on some common characteristics. Compliance failures including failure to ensure that patients see supervising physicians, multiple readmissions, and billing for patients who have not been to a hospital or nursing home are all common issues in home health fraud investigations. 
  • The 5 Pitfalls of Home Health Care – When it comes to compliance, there are five key pitfalls home health agencies need to avoid. These include certification and re-certification errors, marketing contract violations, medical director contract violations, billing mistakes, and lack of adequate documentation. 
  • The Pitfalls of Certifying Home Health Care – Certifying physicians must avoid a number of common pitfalls as well. For physicians who certify patients for home health care, compliance efforts should emphasize accurate “homebound” determinations, treating patients who need skilled services, maintaining adequate supervision, following patients’ established care plans, and ensuring adequate in-person contact with patients. 
  • Recent Examples of Home Health Fraud Investigations – When developing a compliance program, one of the most-effective methods is to examine recent federal fraud investigations. If you know what mistakes others have made in order to garner the government’s attention, then you can plan to avoid those mistakes accordingly. 
  • Home Health Agency Compliance: What Do You Need to Know? – What are some of the most-common triggers for federal home health agency fraud investigations? What are the key components of an effective compliance program? How can you use your compliance program as a defense during a federal investigation? As a home health agency owner or certifying physician, these are all key questions you need to be able to answer. 
  • Home Health Agency Fraud Defense: What Happens if Your Agency is Investigated? – While the ideal scenario is for home health agency compliance to prevent a federal investigation, due to the government’s intense focus on the home health care sector, home health agencies must also be prepared to use their compliance programs as shields during federal investigations. Find out how your compliance program can (and should) protect you when federal agents knock on your door. 
  • What Is an OASIS Assessment? – An Outcome and Assessment Information Set (OASIS) assessment is a requirement for all Medicare and Medicaid beneficiaries who are receiving home health care services. Improper OASIS assessment practices can trigger federal investigations, and adopting an effective compliance program is the key to avoiding costly mistakes. 
  • Penalties in Home Health Medicare Fraud Investigations – What is at risk if your home health agency does not have a compliance program (or if your agency’s compliance program is ineffective)? Learn about the penalties for home health care fraud under the False Claims Act, the Anti-Kickback Statute, the federal health care fraud law (18 U.S.C. § 1347), and various other civil and criminal statutes. 
  • What Home Health Providers Need to Know About Government Investigations – You are confident in your home health agency’s compliance program, but you are (rightfully) still concerned about the risk of being targeted in a federal fraud investigation. Learn more about the importance of compliance, ongoing documentation, and engaging health care fraud defense counsel to avoid costly penalties. 

The good news is this: Unless your home health agency or medical practice is already in the federal government’s crosshairs, it is not too late to make changes that can significantly improve your compliance record. That said, you should upgrade your compliance program promptly, as federal authorities are actively targeting home health care providers for civil and criminal prosecution. 

Are You Ready to Focus on Compliance? Get Started with a Free and Confidential Assessment from the Federal Health Care Lawyers at Oberheiden, P.C.

When you contact our firm about your home health agency’s or medical practice’s compliance needs, we will arrange for you to meet with a member of our team in complete confidence. This initial assessment is free, and it is your opportunity to make an informed decision about moving forward. To discuss how we can help you maintain a compliant practice, call us at (214) 692-2171 or request an initial compliance assessment online today. 

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