5 Steps for Preventing Healthcare Fraud and Abuse at Hospice and Homecare Agencies

Providing quality care and comfort to patients is the primary concern of hospice and homecare agencies. Unfortunately, it’s not the only one. Owners also need to be proactive and vigilant to ensure they are preventing healthcare fraud and abuse.

Whether the fraud is an accident due to negligence or a scam carried out by an unscrupulous employee, hospice and homecare owners must take precautions to legally and financially protect their businesses. The process of safeguarding themselves, their agencies, and their patients begins and ends with their employees. From nurses to accountants to receptionists, healthcare fraud and abuse can be carried out by anyone at any level of the organization.

Here are five steps hospice and homecare agencies can take today to start preventing healthcare fraud and abuse:
1. Implement internal controls: A hospice or homecare agency cannot operate effectively without a defined set of internal controls that ensure compliance with laws and regulations, accurate financial reports, asset protection, and other measures. Essential healthcare fraud and abuse policies and procedures include defining access and authorization controls, as well as separating duties to reduce opportunities for fraud to occur.

2. Hire honest people: This should go without saying, but it can’t be said often enough. When there’s a shortage of quality caregivers and an increase in patients, it’s easier to rely on trust rather than facts. Unfortunately, trust or a “gut-feeling” isn’t enough in the hiring process, especially when a hospice or homecare agency can be bankrupted by just one scam artist. Preventing healthcare fraud and abuse therefore must include background checks on all employees. This includes: Employment verification of companies, positions, performance, length of employment, and reasons for leaving Education verification, including trainings and accreditations Checking criminal and civil records for fraud and other crimes.

3. Educate employees: Hospice and homecare owners must inform employees about their policies and procedures for preventing healthcare fraud and abuse, including the internal controls in place and the consequences of violating them. Employees should sign a form to confirm their receipt of this material, and should undergo regular training on topics related to healthcare fraud. A healthcare fraud and abuse expert can provide a “Lunch and Learn” presentation to educate employees on the threats of fraud and what they can do to prevent it.

4. Institute an employee hotline: A confidential system for employees, vendors, patients, and family members to anonymously report suspicious activity is a simple but effective way to prevent healthcare fraud and abuse.

5. Perform audits: Hospice and homecare agencies should receive annual audits of their financials and operations. Agencies should also conduct random, unannounced audits and fraud assessments to discover vulnerabilities. Random audits also let employees know that preventing healthcare fraud and abuse is a high priority.