Assisted living operators that provide Medicaid home- and community-based services to their residents could be front and center in a new federal initiative aimed at clamping down on healthcare fraud.
Last week, Centers for Medicare & Medicaid Services Administrator Mehmet Oz, MD, asked state Medicaid directors to develop and submit two-year provider revalidation strategies. It also asked states to increase oversight of “high-risk” providers.
The provider revalidation strategies must include information about how states ensure the accuracy of provider enrollment data through revalidation or provider directory validation. CMS also called for states to adopt off-cycle or more frequent revalidation intervals than the minimum five-year requirements for providers states consider high-risk.
“CMS recognizes the significant challenges that states…
This category refers to crimes committed by employees or insiders against their own organizations. It is often the most damaging because the perpetrator has authorized access to systems.
- Asset Misappropriation: The most common form, involving the theft of company resources. This ranges from simple “skimming” (taking cash before it’s recorded) to complex schemes involving the theft of inventory or intellectual property.
- Payroll Fraud: Employees may create “ghost employees” on the system, falsify their own timesheets to claim unworked overtime, or divert salary payments to their own accounts.
- Financial Statement Fraud: Management deliberately misrepresents the company’s financial health by inflating revenue or hiding liabilities to attract investors or meet performance bonuses.