Fraud, Waste, and Abuse: Fundamentals of Compliance
in Home Health and Hospice
Presented by Cathleen Armato
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Non-Financial: Cathleen Armato has no competing non-financial interests or relationships with regard to the content presented in this course.
26% of the national budget is spent on Medicare, Medicaid and the Children’s Health Insurance Program (CHIP). The National Health Care Anti-Fraud Association (NHCAA) estimates that our nation loses tens of billions of dollars each year due to health care fraud. This course will review fraud, waste, and abuse and how providers and their employees can participate in compliance efforts to stem the flow of inappropriate payments and preserve these programs for our future. The course will review rules and laws governing home health and hospice, risk areas for home health and hospice, and proactive steps employers and employees can take to remain in compliance with program requirements.
Meet your instructor
Cathleen Armato
Cathleen Armato is an experienced executive with 22 years in the home care and hospice industry. She has served in various roles during that time, including VP of operations and chief compliance officer for a nationwide healthcare provider. In 2012, Cat became a consultant. Since that time, she has assisted multiple…
Chapters & learning objectives
1. Defining Fraud, Waste, Abuse and Errors
This chapter defines errors, waste, abuse and fraud and gives examples of each. Through better understanding of these definitions, employees will be positioned to recognize opportunities for improvement in their organization.
2. Laws and Programs Governing Healthcare
This chapter reviews the four primary regulations that affect the home care and hospice industry. The False Claims Act will be reviewed including its history and rationale. Anti-Kickback, Stark, and exclusions will also be reviewed to provide clarification so providers and clinicians are better informed and can make good decisions on their day-to-day activities.
3. Elements of an Effective Compliance Program
This chapter reviews the 7 Elements of an Effective Compliance Program as defined by the Office of the Inspector General (OIG). Understanding these elements will help the clinician look for those resources within their own organizations that can assist them in compliance efforts. Each element is reviewed so the clinician will understand why home health and hospice providers carry out specific activities, such as auditing and monitoring.
4. Home Health and Hospice Risk Areas
This chapter reviews the highest risk areas for a home health and hospice provider. Major risk areas for each provider type are listed and discussed. With this information, the clinician is better able to recognize and proactively report any compliance concerns.
5. Individual Responsibilities
Compliance is not the job of one person or one committee. It is the responsibility of every individual within the organization. This chapter reviews individual responsibilities in reporting a concern and cooperating in an investigation. We will also discuss non-retaliation and what you should expect from your employer.
