Aug 7, 2014 • 21M

Medicare Fraud in Home Health: A Conversation with Sherill Mason (August 6th)

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Appears in this episode

David Introcaso, Ph.D.
Podcast interviews with health policy experts on timely subjects. The Healthcare Policy Podcast website features audio interviews with healthcare policy experts on timely topics. An online public forum routinely presenting expert healthcare policy analysis and comment is lacking. While other healthcare policy website programming exists, these typically present vested interest viewpoints or do not combine informed policy analysis with political insight or acumen. Since healthcare policy issues are typically complex, clear, reasoned, dispassionate discussion is required. These podcasts will attempt to fill this void. Among other topics this podcast will address: •Implementation of the Affordable Care Act •Other federal Medicare and state Medicaid health care issues •Federal health care regulatory oversight, moreover CMS and the FDA •Healthcare research •Private sector healthcare delivery reforms including access, reimbursement and quality issues •Public health issues including the social determinates of health Listeners are welcomed to share their program comments and suggest programming ideas. Comments made by the interviewees are strictly their own and do not represent those of their affiliated organization/s.
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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.