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How We Guard against Home Healthcare Fraud

In February of this year, a major Medicare fraud scheme was discovered in southeast Michigan with 23 individuals being charged with several healthcare-related crimes. The perpetrators defrauded Medicare with $61.5 million in kickbacks, bribes, and Medicare bills for services that were either medically unnecessary or never provided. Patients were also exposed to excessive drug testing and falsely certified with inaccurate medical conditions. 

Direct Care Innovations takes healthcare fraud seriously which is why we have several safeguards in place to protect patients and healthcare agencies from being victims of illegal and unethical healthcare crimes. Learn more about our EVV solutions, real-time authorization management, and custom care plans and how they can help to prevent these types of fraudulent actions.

How We Guard Against Home Healthcare Fraud

Electronic Visit Verification

With our electronic visit verification software, your agency can ensure compliance for services that are delivered remotely in community settings or private homes. Our software has GPS-enabled location tracking that records where and when services were delivered. It also includes Geofencing, a valuable tool that triggers a mobile response and sends real-time alerts when virtual boundaries have been crossed. Other protective settings provided by our EVV module include these:

  • Real-time shift tracking
  • Facial recognition technology
  • Budget management
  • Expiring authorization notifications and overtime alerts

Real-Time Authorization Management

An important method for protecting against fraud is the ability to track and authorize services in real-time. Our authorization management module does exactly that and provides a system of record so healthcare agencies can access and maintain their service authorizations. In addition to these key features, our real-time authorization management module includes the following:

  • Monthly authorization budget management
  • Daily, weekly, and monthly authorization limits
  • Record system for all billing transactions
  • Real-time declining balances for under or overutilization prevention

Care Management Software

Ensure your patients are receiving the care they’ve been authorized and your DSPs are being compensated for their valuable work with our care management software. It can be easy to let things slide when you have several DSPs and clients under your supervision. You can prevent accidental or intentional fraud with these customizable software capabilities:

  • Accurate outcome tracking
  • Customized goal and task tracking
  • Multiple custom care plans
  • Downloadable reports in PDF and Excel

Avoid Healthcare Fraud & Protect Your Business

The best way to avoid fake claims or forged care authorizations is to prevent them altogether with state-of-the-art business management software from Direct Care Innovations. Request a sales demo when you call us at (480) 295-3307 to learn more about healthcare management modules.

Source: “Twenty-Three Individuals Charged in $61.5 Million Medicare Fraud Schemes.” Web press release. The United States Department of Justice. 07 Feb. 2023. Web. 31 Mar. 2023. 

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