decisionhealth Newsletters, Answer Books - 2009 Issue 3 (March)
Fraud Alerts / OIG Special Fraud Alerts / Special Fraud Alert_March 1998 / Background
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Article Overview
This article provides background for a special fraud alert on relationships between nursing homes and hospices. It explains why these arrangements can create fraud and abuse risk, the general financial incentives involved, and why the Office of Inspector General viewed the setting as vulnerable to improper influence. It is relevant to compliance staff, hospice and nursing home administrators, billing and coding personnel working in post-acute care, and anyone responsible for fraud prevention policies.
Why This Topic Matters
The article helps readers understand a high-risk business relationship in post-acute care and why oversight bodies scrutinize referral and contracting practices in this setting. It is useful for identifying compliance exposure and for placing later guidance in context.
What You Will Learn
- Why hospice and nursing home relationships are considered vulnerable to fraud and abuse
- How access to residents can create financial and operational incentives
- What broad compliance concerns are associated with exclusive or semi-exclusive provider arrangements
- Why this setting received scrutiny from the Office of Inspector General
Who Should Read This
- Compliance officers
- Hospice administrators
- Nursing home administrators
- Billing and coding professionals
- Healthcare attorneys
- Fraud prevention teams
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