In its efforts to prevent alleged widespread fraud in Medicare, federal regulators have blocked for at least six months any new home health and hospice providers from participating in these federal programs. This strategy may succeed in grabbing headlines but it won’t stem corruption and may limit access to care for many who need it.
In the name of fraud prevention, the initiative appears part of a broader Trump Administration effort to restrict access to federal health and long-term care, especially through Medicaid. In recent weeks, it has slashed Medicaid payments to states such as Minnesota, and California, and threatened to cut others. All in the name of what it claims is widespread fraud, though it has provided no evidence of extensive corruption. The new initiative focuses on Medicare.
How Much Fraud Is There?
In both programs, provider fraud is real and not new. Unscrupulous…
MANAGEMENT & CULTURE (THE “TONE AT THE TOP”)
Fraud thrives in “sloppy” environments where leadership ignores the rules.
- The Fraud Triangle: For fraud to occur, three elements must be present: Pressure (the need for money), Rationalization (thinking “I deserve this”), and Opportunity (weak controls). You can only control the Opportunity.
- Whistleblower Hotline: Provide an anonymous way for staff to report “odd behavior.” Most internal frauds are caught via tips, not audits.
- Background Checks: Conduct credit and criminal record checks for all employees in financial or data-sensitive roles.
- Annual Ethics Training: Make sure every staff member knows that the company has a Zero Tolerance policy toward “borrowing” from petty cash or fudging overtime.