Fraud Prevention
Did
you know?
The
penalties for determination of Medicaid fraud for a single
given session includes $11,500 per session + double the
reimbursement received for the session (for situations
listed below), as well as the government’s legal
fees.
Understanding
Fraud Prevention:
The possibility of potential allegations is nightmarish
for most agency directors, given the likely misinterpretation
of inadvertent:
-
Zero travel time between sessions
- Overlapping sessions
- Back to back sessions (in different homes)
- Too little travel time between sessions
The
best case scenario is one in which the therapist in question
treated a non-Medicaid eligible child, resulting in the
recoupment of fees paid for the sessions in question.
If overlapping or zero travel time occurred with respect
to two children, recoupment of funds paid occurs for both
children, irrespective of whether services actually occurred,
in accordance with early intervention regulations. Considering
that early intervention is an ever skyrocketing government
expense, it is no wonder that government regulators are
expending efforts toward recoupment of funds because of
inadvertent error, or worse – because of Fraud.
Occurrences
of this type have happened throughout the Country, in
many cases resulting in arrests, fines, and prison time.
(See adobe articles on fraud)
Our Solution:
EISS
provides a patent pending cross-referencing web-based cartographic mapping filtering dual module that checks
all therapists in your database for possible overlapping
sessions, back-to-back sessions (indicating zero travel
time – unless, for example, both children lived
in the same home). Inadvertent therapist error can be
detected, and notes mailed back to therapists so that
may make corrections. Our software allows the owners and
directors of early intervention programs to rest easy
and worry free of possible allegations of fraud.
Enjoy the peace of mind which accompanies our unique automated fiscal audit for every billing submission- prior to submission. Our patent-pending module allows unparalleled prevention and detection of what may be inadvertent error, or outright fraud, allowing you to identify and legally redress this matter, prior to billing.
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