Your Fraud
Prevention Checklist
 Be informed.
It is important to understand Medicare eligibility criteria, coverage
guidelines, billing and cost report requirements. Seek clarification from
your Carrier or Fiscal Intermediary as necessary and attend training opportunities
by CMS and Medicare contractors.
Be
an educator.
Keep beneficiaries (patients) properly informed and educated about the
care you are providing, and ensure the physician is actively involved
in the planning and delivery of your service to the patient. Many recent
OIG hotline reports by beneficiaries relate to billing and service issues.
A provider can prevent inappropriate referrals about them from beneficiaries
if they have informed patients and family members. Always provide complete
and accurate information to beneficiaries according to your Condition
of Participation requirements.
Be
in compliance.
If your agency does not have a compliance program in place, development
of one should be considered. The Office of Inspector General (OIG) has
developed a number of compliance programs for agencies to use as guides,
including one for home health agencies. These programs can be found on
the OIG Internet site at http://www.oig.hhs.gov,
or, by contacting the OIG directly.
Be
a responsible employer.
Every provider should be aware of and use the Office of Inspector General's
Sanction List. This list identifies Medicare providers who have been restricted
from participation in government programs. For a provider's protection,
the list should be checked prior to hiring new employees to ensure the
government has not sanctioned the prospective employee. The OIG Sanction
List can be accessed via the OIG Internet address identified above.
Be
a Medicare Anti-Fraud Team member.
Report fraud and abuse when you have information that supports Medicare's
definition of fraud. The OIG has a fraud hotline (1-800-HHS-TIPS), as
well as many contractors have a Benefit Integrity department. |
