SEATTLE (June 18, 2009) – OCS HomeCare announces its newest offering for home health agencies—Risk Profile Analysis. This timely publication helps prepare home health agencies for the imminent increase in audits from multiple regulatory entities to identify Medicare fraud and abuse patterns.
Risk Profile Analysis provides an overview of performance data on a variety of regulatory-related metrics, including 30 indicators that state and federal entities may use to evaluate suspect tendencies and potential recoupment value for your agency. You will benchmark your data with the industry’s largest homecare database and gain perspectives on local variations within your region. If you have multiple agencies, you can quickly determine which ones need focused attention and assistance.
Brief Background
On May 20, 2009, President Barack Obama signed the Fraud Enforcement and Recovery Act into law, introducing sweeping changes to the False Claims Act and providing hundreds of millions of dollars for enforcement. On the same date, Attorney General Eric H. Holder Jr. and Health and Human Services Secretary Kathleen Sebelius announced a new and aggressive interagency task force called the Health Care Fraud Prevention and Enforcement Action Team (HEAT) to combat Medicare and Medicaid fraud.
The Obama administration has repeatedly remarked that the current model of healthcare is unsustainable and that any healthcare reform plan must work to curb skyrocketing expenses for the Centers for Medicare and Medicaid Services (CMS). The administration’s goal is to cut $313 billion from CMS over the next 10 years [source]. Healthcare fraud enforcement is clearly a top priority of the Obama administration to recover a portion of this amount.
Impact on Home Health Agencies
In the near future, several regulatory entities will begin to clamp down on the healthcare industry, especially home health agencies because of a 44% increase in Medicare spending over the last five years [GAO source; source]. As a result, providers should expect to come under increased scrutiny from several different regulatory bodies, including:
• Recovery Audit Contractors (RACs) – RACs just completed a three-year demonstration project during which they recouped $992.7 million in CMS overpayments for a net gain of $693.6 million [RAC source; source]. RACs have been funded to continue this effort indefinitely.
• HEAT Enforcement – HEAT has been funded to detect fraud and abuse over the next 10 years. The program is expected to return $2.7 billion in overpayments in its first five years.
• The Office of the Inspector General (OIG) – OIG recently conducted research that has uncovered wide variations in home health billing across individual providers.
Risk Profile Analysis Can Help
Tracking and trending several areas of likely investigative interest will help you understand your potential risk of investigation and your possible exposure during an audit. Risk Profile Analysis saves you many hours of preparatory work—simplifying the process by doing the analysis for you, providing it in an easy-to-read format, and supplementing your internal investigation with comparative data research that offers a perspective of how you measure up to other organizations nationally and regionally.
At a time when healthcare reform topics are at the forefront of the national dialogue, OCS continues to solidify its position as the national leader in healthcare data intelligence. To find out more about Risk Profile Analysis, please write to info@ocsys.com, call 888.325.3396, or visit the solutions page.
About OCS HomeCare
OCS HomeCare empowers home health and hospice organizations with results-driven data intelligence, plus the largest and most accurate homecare databases for those industries. Homecare providers, payers, associations, government agencies, vendors, and consultants all turn to OCS to elevate decision-making, raise the bar on results, and bring home positive outcomes. For more information about OCS HomeCare, please visit www.ocshomecare.com or call 888.325.3396.