It’s an exciting time for HealthStar. This week, our company was featured in the Knoxville News Sentinel as well as on USA Today. Our founder and CEO Dr. Ed Breazeale spoke about a number of issues plaguing the healthcare system, including the fraud, waste, and abuse that often occur in Medicaid reimbursement for home health services. As the article notes, “nearly $3.6 billion in personal care services were paid improperly in 2015,” according to the U.S. Department of Health and Human Services.
"In the outpatient world, nobody’s watching. It's that caregiver, that provider, driving around in a car, and they’re supposed to give grandma or granddad or aunt or uncle a certain amount of care," Breazeale said.
Dr. Breazeale also explained how HealthStar’s patented electronic visit verification (EVV) technology reduces system cheating through GPS. Within the first few months of implementing HealthStar Visit, our technology flagged a care giver attempting to bill services from Egypt while visiting family.
"The question is, 'Does that care get delivered or not? How much time did they spend?' ... If you're cheating the patient or you're not doing what you're supposed to do, you’re not only cheating the patient but you're cheating the system."
Krista Pelensky, HealthStar vice president of operations, chimed with another example of how providers can "cheat the system."
"We have documented cases where, for example, a care giver would check in at a patient's home and then the claim got kicked out, because the check-out did not meet the criteria," Pelensky said. "You can look and see that the check-outs were across the river in Memphis at the casino."
Read the story in full here. This story originally appeared on KnoxNews.com on November 7, 2017.