The state of modern health care is constantly in flux, as the worlds of medicine and technology continue to converge and reshape one another. With innovation and reform happening more rapidly than ever before, we’re predicting 2019 will be a breakthrough year for the industry and its stakeholders. Some of those breakthroughs will be technological, while others will have more to do with our approach to patient care.
We spend lot of time talking about fraud, waste, and abuse – three of our industry’s most serious ills. Acknowledging these systemic problems creates a platform for discussion and legislative reform which, in turn, results in better care for patients. But in our haste to highlight where the system is falling short, we sometimes fail to mention how our industry is moving in the right direction. To know where you’re going, you must remember where you’ve been.
Neglect and fraud have become rampant in home care settings at large. This month, the Office of the Inspector General published a federal report analyzing hospice patient and Medicare payment data dating back to 2005. The report highlighted findings of fraud and neglect as well as serious vulnerabilities in the Medicare hospice program.
According to a new Government Accountability Office (GAO) report, Health and Human Services (HHS) made approximately $90 billion in improper payments to Medicaid and Medicare programs in 2017. Improper payments are often made due to undocumented services, uncertified personal care assistant (PCA) workers, and services billed while members were institutionalized and therefore not authorized to receive services.