Medicare Fraud Is Driving Payers’ Demand for Electronic Visit Verification

Aug 16, 2016 7:38:11 AM

The dog days of summer proved to be far from lethargic for the U.S. Department of Justice this year. In one late-July week, the DOJ charged three people in a $1 billion scheme of conspiracy, obstruction, money laundering and health care fraud. It was the single largest criminal case in the nine-year history of the Medicare Fraud Strike Force.

fraud_320px.jpgThat hammer blow came one month after the Strike Force, along with the Medicaid Fraud Control Units of 23 states, brought civil and criminal charges against 301 people in scores of schemes that totaled $900 million in allegedly false billings.

With the pressure to plug the holes that allow such fraud to occur, many states are taking steps to ensure they will receive better proof of care delivered before they make reimbursements.

As of late 2015, nearly half of all states have mandated some form of electronic visit verification (EVV) to improve documentation that, at a minimum, a visit did occur. Among those mandates though, states take varying approaches to how agencies must implement an EVV system:

  • 4 states mandate a specific EVV solution
  • 7 states require an EVV solution, but don’t specify a vendor
  • 11 states mandate the use of an EVV system and suggest a preferred vendor
For agencies that operate in multiple states, this can create compliance headaches that don't appear will be eased any time soon.

 Multiple Approaches to EVV

The Federal government has proposed legislation that would, by 2019, would require home care agencies to submit proof of services delivery for reimbursement. As the deadline approaches, and with the expectation that in-place systems will be grandfathered in as acceptable EVV solutions, many states are scrambling to define their own requirements rather than waiting for the Feds to do the job for them. 

Five common methods of visit verification typically get the most attention:

  • Electronic random number match devices
  • Biometric recognition
  • On-site dedicated tablets
  • Telephony
  • Mobile devices

Ironically, some of these technologies solve the visit verification problem, but do nothing to address the risk of fraudulent claims based on services not actually delivered.

In fact, many agencies are discovering that, of these five forms of EVV technology, mobile solutions that go beyond proof of visit and instead optimize care and services delivery offer a better approach.

To learn more about how a comprehensive EVV solution can mitigate business risk while improving the bottom line, read our white paper, Considering Electronic Visit Verification? Go Beyond Simple Proof of Visit.

Topics: Electronic Visit Verification, EVV