Home health care fraud remains a problem for agencies. Last year, Medicare and Medicaid fraud topped more than $100 billion. As a care provider, fraud can inflate your treatment costs, which cuts into your revenue stream. False claims are a common source of fraud in the industry.
You can cut back on fraudulent claims with accurate medical documentation. WorldView offers a comprehensive document management solution that keeps your patient data safe and reduces the risk of fraud.
Understanding Fraud in Home Health
The definition of fraud in home health care is when a person knowingly provides false information to get an unauthorized benefit. People committing fraud in home health care often misrepresent the length of time for patient care, submit false claims with fake medical records, and submit bills for patients who aren’t receiving care at home.
Identifying Vulnerabilities
Billing fraud is one of the most common vulnerabilities faced by home health care agencies. To inflate bills, team members may be upcoding or billing for more expensive services than provided. You might also see bills for services patients never received or bills for patients who are not home-bound.
It's also common for home health professionals committing fraud to conduct unnecessary home services and bill for services that don’t have a corresponding physician order. You can minimize your fraud risk by auditing your billing and documentation processes and finding areas where it would be easier to commit fraud.
Prevention Strategies
When managing a home health care agency, it’s important to trust your employees. However, your agency is always somewhat vulnerable. Follow these tips to reduce your risk.
Implement Robust Internal Controls
Put processes in place to prevent home health care fraud. Start by segregating duties so you have checks and balances in place to prevent fraud. Make sure everyone on your team knows who has the authority to approve various transactions.
Implement a reporting system. If any of your team members are wondering, “How do I report fraud?” give them a clear procedure. Make the process anonymous so your team members don’t have to fear harassment or retaliation.
Finally, pay attention to your data analytics. If you notice an uptick in upcoding or other potentially fraudulent activity, make note and investigate further.
Conduct Regular Audits
Schedule regular audits so you can spot potential fraud before it becomes a large-scale problem. Use software to analyze your bills and match claims with electronic health records (EHR). Regular audits help detect potential fraud early and keep your team members honest.
When you’re conducting an audit, check for common billing and documentation errors. Look for patterns of overbilling or underbilling. Review patient records and caregiver schedules to make sure your team is only visiting patients when they have authorization to do so.
Human errors are inevitable, but regular audits can help you see patterns that could indicate fraud.
Educate Staff and Caregivers on Fraud Prevention
Involve your staff in fraud prevention. Set up training on common types of fraud and their impact on your business. Teach them how people who commit fraud typically conceal their actions and encourage each employee to pay attention to signs of fraud.
The Role of Technology in Fraud Prevention
Shifting to EHR and other technologies can help cut down on fraud by removing the ability to commit it. Advanced documentation tools allow you to match physician orders and referrals with procedures. Digital billing tools can flag coding errors so you catch them before submitting a claim.
Emerging document management systems and digital billing software use artificial intelligence (AI) to automate parts of your process. An AI-powered tool can verify a patient’s eligibility to receive care and automatically match codes with their respective procedures. AI can also evaluate a lot of data quickly. Use it to analyze your patient records and medical bills to track patterns and identify abnormal activities.
EHR and document management systems have helped agencies prevent fraud. In some cases, these documents serve as legal evidence to prove that an agency actually provided the billed services.
Streamlining Documentation Processes
Maintaining accurate documentation about patient visits and procedures is critical in preventing fraud. Use digital documentation platforms to create standardized templates that allow your caregivers to organize their notes and accurately detail their services.
Meet with your clinical team to map your current processes for collecting, reviewing, updating, and validating data. Identify areas where you could be duplicating information or not collecting enough data. Once you've mapped out your process, assess the parts that pose the highest risk for fraud and make necessary changes or eliminate them.
WorldView makes home health documentation more efficient. You can easily share and store documents, match bills with patient records, collect electronic signatures, and manage physician orders.
With WorldView’s platform, your team can store and access all patient records in one location. Caregivers can add notes and photos to patient records in real-time, which helps reduce the chances of upcoding and billing for services that were not completed.
Conclusion
Home health care fraud is costly for both providers and caregivers. Fraud also leads insurance providers to change their rules for claims and approvals. Since providers deal with the financial impacts of fraud, they often pass these costs on to you. You may see your costs to treat patients increase and experience a higher volume of claim denials.
Fortunately, technology is improving. Tools such as EHR and AI-powered health record systems make it easier to identify patterns of fraud early on. These tools also let you automate your documentation processes, making it more difficult for dishonest employees to commit fraud.
Prevent fraud by establishing a culture of security. Implement internal controls and training programs to keep your employees accountable and make sure they know how to report fraud.
WorldView’s solutions can help you reduce the risk of fraud in your health care agency. Schedule a demonstration to learn more about how we can help you.
