decisionhealth Newsletters, Answer Books - 2009 Issue 3 (March)
Hospices / Fraud Alerts / Background
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Article Overview
This article explains why hospice relationships with nursing homes can create fraud and abuse risk, especially when access to residents is limited by exclusive or semi-exclusive arrangements. It is intended for compliance, billing, and healthcare operations audiences who need a high-level understanding of the financial and operational factors that can make these relationships vulnerable to illegal remuneration. The content provides background context rather than coding guidance and discusses broad hospice and nursing-home service delivery issues.
Why This Topic Matters
Hospice and nursing home arrangements can have significant financial and compliance implications, making it important for organizations to recognize situations that may increase fraud and abuse exposure.
What You Will Learn
- Why certain hospice arrangements with nursing homes can create fraud and abuse concerns
- How access to nursing home residents can affect hospice business relationships
- What broad financial and operational factors may increase compliance risk in these settings
- Why these arrangements are relevant to fraud alert and compliance review audiences
Who Should Read This
- Compliance officers
- Billing and coding professionals
- Hospice administrators
- Nursing home operators
- Healthcare auditors
- Revenue cycle staff
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