There has historically been a lot of fraud in home care billing. The federal government has a branch called the OIG (Office of Inspector General) that is dedicated to monitoring, researching, investigating, and prosecuting Medicare and Medicaid fraud. There is also an OIG at the Minnesota state level.
When people commit fraud and are found guilty, they are put on what’s called an OIG exclusion list, which means they can never again work in a business or facility that bills Medicare or Medicaid. If that is a person’s chosen profession, committing Medicare and Medicaid billing fraud is a ridiculous risk that could end a career.
Medicare and Medicaid billing fraud is when an organization bills Medicare or Medicaid for services or products not actually provided. An example of this would be billing for a PCA who didn’t actually do a shift, or billing for a skilled nurse visit that wasn’t performed. Communities of Care runs an OIG background check on every single employee in our organization, in addition to the Minnesota Criminal Background Check. We want to ensure that we are complying with all regulations from the OIG.
We take our billing responsibility very seriously, ad will continue to ensure that we only work with like-minded, ethical nurses.
For further and more specific information, please consult the Center for Medicare and Medicaid Services (CMS) website.