Some healthcare fraud can’t be fully investigated from behind a computer.
Home health is a perfect example.
Federal enforcement continues to focus heavily on this sector.
On August 4, DOJ announced charges against 19 defendants in Medicaid home health aide schemes, while HHS-OIG’s recent enforcement activity includes multiple home-care-related cases.
Home-based care creates a unique program-integrity challenge:
Was the patient actually there?
Was the caregiver?
Were the claimed hours worked?
Were the services medically necessary?
Does the provider actually operate where they say they operate?
Does what exists in the real world match what appears in the claim?
Analytics can identify the anomaly.
Sometimes an investigator needs to determine whether reality matches the data.
That’s the difference between detecting risk and investigating it.
#HomeHealth #ProgramIntegrity #FWA #HealthcareFraud #FraudInvestigations #SIU #PaymentIntegrity #HealthcarePayers #Medicaid #Investigations #SpecialInvestigationUnit #HealthcareAI
