Hospices and Home Health Agencies’ Compliance Risk Areas

Hospices and Home Health Agencies’ Compliance Risk Areas
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Hospices and Home Health Agencies’ Compliance Risk Areas
Hospices and home health agencies hold significant responsibilities in providing healthcare services to the nation’s most vulnerable populations. Based on a 2021 report by the Centers for Disease Control and Prevention (CDC), the United States of America (USA) has over 12,000 home health agencies, where 98.7% are certified by Medicare and 78.4% are certified by Medicaid (Branan & Sena, 2021). The paper identifies ten compliance risk areas that are unique to hospices and home health agencies.
Home health agencies’ compliance risk areas include inappropriate referral relationships, anti-kickback statute, stark and civil monetary penalties law, medical necessity, the Health Insurance Portability and Accountability Act (HIPAA), and excluded entities (Branan & Sena, 2021). Others are inadequate documentation, quality of healthcare services, overpayment, and the Office of Inspector General (OIG) compliance oversight. Home health agencies are allowed to partner with third parties to promote their services. However, they should adhere to the anti-kickback statute, stark law, and the civil monetary penalties law. For instance, the anti-kickback statute prohibits home health agencies to enter into relationships with entities that might induce the referral of beneficiaries for health plans. The civil monetary penalties law ensures that home health agencies do not induce patronage from patients by giving gifts valued at over $75 per year (Branan & Sena, 2021). Home health agencies must have experienced physicians who can provide standard healthcare services, such as diagnosing and treating patients. The privacy of patient information ought to be safeguarded at all times, which is why these entities must comply with the HIPAA. There should be no billing of services that are not medically necessary. Home health agencies should have proper documentation or license, and they should comply with the guidelines from the OIG. Besides, patients should not be...