decisionhealth Newsletters, Answer Books - 2009 Issue 3 (March)
Nursing Facilities / Fraud Alerts / Special Fraud Alert - March 1998 / Background
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Article Overview
This article provides background on fraud and abuse concerns involving nursing homes and hospices, with emphasis on the business dynamics that can make referral arrangements financially valuable and potentially risky. It is relevant to compliance staff, facility administrators, hospice providers, and auditors who need a general understanding of the issues highlighted in an OIG special fraud alert. The article covers the role of exclusivity, patient access, overlapping services, and the potential for improper remuneration in these relationships.
Why This Topic Matters
Understanding these arrangements helps organizations recognize compliance risk areas in post-acute and hospice referral relationships and better assess where fraud alert scrutiny may arise.
What You Will Learn
- Why nursing facility and hospice relationships can attract fraud and abuse concerns
- How access to residents and service overlap can create financial incentives
- What general compliance risks are associated with exclusive or semi-exclusive referral arrangements
- Why these business relationships are monitored by the OIG
Who Should Read This
- Compliance professionals
- Nursing facility administrators
- Hospice providers
- Health care auditors
- Revenue integrity teams
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