Medicare billing fraud is pervasive. It's estimated at $50 to $60 billion annually or approximately 10% of all of Medicare spending. While billing fraud is committed in numerous ways from never performed procedures to fake patient care, it's possibly no more prevalent than in home health care, an industry of 12,000 providers whom bill Medicare $18 billion annually. For example, a 2010 DHHS Office of the Inspector General report found one in every four home health agencies had unusually high billing. In one example, federal officials in 2012 arrested a Texas-based home health provider accusing him and his colleagues of running a $375 million home health scam.
During this 21 minute interview Sherill Mason defines home health, discusses how home health is reimbursed, how fraud or improper billing is committed via for example upcoding and over utilization, where, the prevalence of the problem, what CMS is doing to try to curb fraudulent behavior, rule making solutions and whistle blower (qui tam) suits.
Sherill Mason is currently Principal, Mason Advisors, where she provides strategic planning, program development and operations analysis for post acute care providers including senior living and nursing home facilities, home health, hospice, long term acute care hospitals, in patient rehabilitation facilities, and long term care pharmacy. Previously, Sherill she served as a Vice Presient to the Marwood Group, a healthcare industry consultant, as Senior Vice President at Sunrise Senior Living and as a Director at KPMG. Among other current professional activities Sherill currently is a Guest Lecturer at the University of Pennsylvania School of Nursing. She received her RN diploma and training at the Englewood Hospital School Nursing and a BA in American Studies from Eckerd College.