2015 Annual Training Conference & Anti-Fraud Expo
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Hospice Storm Project: Identifying Hospice Fraud in the Medicaid Program
(
Room
Seaport H
)
20 Nov 15
9:45 AM
-
11:00 AM
Tracks:
Fraud Schemes and Investigative Skills, Law Enforcement Path
Speaker(s):
Christopher Covington, Special Agent in Charge, U.S. Department of Health and Human Services, OIG-OI;
David Delgado, Criminal Investigator, Medicaid Fraud Control Unit of Mississippi, OAG
Faculty examines the group therapy visit, with a focus on the behavioral health benefit, correct coding and best clinical practices. Common schemes will be discussed with the focus on detection and prevention of abusive patterns of billing.The presentation will focus on the epidemic of hospice fraud in Mississippi with an emphasis on the 'Hospice Storm' project which seeks to identify, investigate and prosecute fraudulent hospice providers. The workshop will begin with an overview of hospice fraud in Mississippi which often originates with door-to-door solicitations by patient recruiters and collaboration by 'medical directors' who are paid by hospices to falsely certify that patients are terminally ill. There will be a general discussion of techniques to identify potentially fraudulent hospices using data analytics such as finding patients who have been on the benefit for extended periods of time. The remainder of the presentation will be a case summary of the successful investigation of Angelic Hospice. The owner of this hospice pled guilty to an $8 million fraud and was sentenced to nearly 6 years in prison in December 2014.
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