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Protecting Your Hospice: Understanding and Preventing Hospice Fraud

As a hospice provider, it is your utmost responsibility to provide top-quality care to patients while adhering to legal and ethical guidelines. Any fraudulent activities can lead to grave criminal consequences that can jeopardize your business operations entirely. That’s why it is crucial for hospices to understand hospice fraud, how to prevent it, and when the need arises, get legal representation immediately.

What You Need To Know About Hospice Fraud
Hospice fraud occurs when hospice providers intentionally bill Medicaid or Medicare for services not provided or exaggerate the patient’s medical condition so they can receive higher reimbursement rates. Additionally, some providers may admit patients who don’t meet the qualifying criteria for hospice care. Below are common types of hospice fraud:

Types Of Hospice Fraud
Description

Billing Fraud
Involves billing patients for medically unnecessary procedures or not done at all.

Kickbacks & Bribes
Offering or accepting gifts in expectation of purchasing influence or gaining referrals

False Certification
Certifying medically unqualified patients as eligible for hospice care

Patient Dumping/Incorrect Discharge
Discharging or transferring patients before due time without proper notification

Ways To Avoid Hospice Fraud
To avoid such unpleasant circumstances, hospices need effective compliance programs in place that identify any potential risks and ensure all laws and regulations are adhered to. Creating these programs involves several components listed below:

Assess Potential Risks Regularly- Conduct regular assessments on every aspect of your organization’s operations and identify potential areas with risks of fraud.

Create And Reinforce Policies- Develop policies and procedures that strictly promote ethical conduct within your hospices’ work environment, including billing standards documentation policies.

Employee Education- Educate staff members on the practices in their roles regularly; this could include training them to prevent fraud, and safe practice policies.

Monitor And Audit Effectively- Implement mechanisms to monitor and audit hospice operations, claims, and billing processes to quickly identify and respond to potential fraud elements. Conduct corrective measures once identified.

Report Suspected Cases To The Right Authorities- Staff members are encouraged to notify management of any suspected fraudulent activity so that corrective measures could be taken promptly.

When To Get Legal Representation
Hospice providers undergoing an investigation should seek legal representation immediately. Healthcare fraud defense attorneys can guide hospices through the initial stages of investigation safeguarding their rights and protecting them against both criminal charges or civil penalties. A healthcare fraud defense attorney’s responsibilities can include conducting internal investigations, responding to subpoenas or search warrants from law enforcement agencies or representing your organization in administrative proceedings.

As summarized earlier, instances of hospice fraud can result in dire consequences for hospices. As such, it is essential that as a provider, you implement effective compliance programs and seek legal representation should a threat arise. Let ‘prevention is better than cure’ be the watchword!