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For FY 2002 the OIG reported savings of over $426 million in audit disallowances, and $1.49 billion in investigation receivables. In addition, the OIG reported exclusions of 3448 individuals and entities for fraud or abuse of the federal health care programs and/or their beneficiaries, 517 convictions, and 236 civil actions. |
Challenge: A national hospice provider was instructed by the Health Care Financing Administration to close down one of its agencies due to numerous violations of the Medicare Conditions of Participation. This client was also at risk in 4 other locations. The client also identified inadequate leadership, resulting in loss of market share and excessive staff turnover.
Outcome:
- Entered into an agreement to manage operations. Our team reported to CEO and Board Chairman
- Managed a $98 million budget with 32 offices nationwide
- Realized $7.7 million in operations efficiency within 8 months
- Increased the patient admission conversion ratio by 26% to 88%
- Increased the length of stay by 24 days to 79 days and the market penetration by 26%
- Implemented audit tools to ensure regulatory and clinical compliance, reduced claim denials, and improved accounts receivable collections
Challenge: As a result of a patient complaint, a survey by the Health Care Financing Administration found nine (9) violations of the Medicare Conditions of Participation and decertified this national home health and hospice provider in a specific marketplace. This client was subsequently advised by the State in which it operates that its license was revoked. An internal audit revealed similar compliance issues in most of its locations.
Outcome:
- Entered into an agreement to manage operations. Our team reported to Health System's CEO and the Board of Directors
- Implemented a compliance plan to meet all regulatory guidelines
- Wrote a plan of correction based on the survey findings that were acceptable to HCFA and the State Agency
- Identified and corrected the organizational problems that led to non compliance
- Negotiated with HCFA to rescind the decertification in lieu of a 30 days penalty
- Reduced the fines levied by HCFA and the State Agency by 81%
- Created and implemented a "Synergy Program" to achieve a continuum of care for the Health System's patients by coordinating services between the hospitals, long term care facilities, and other entities owned and operated by the Health System
- Managed a $51 million budget
- Managed 19 offices, 2 inpatient facilities, one HME center and an infusion pharmacy
- Realized cost savings of $4.4 million
- Increased the conversion ratio by 17%, the length of stay by 14 days, and the market penetration by 29%
- Increased staff productivity to 5.6 visits per day
- Achieved a net income of 28.4%
Challenge: A large health system discovered through a financial audit that $7.5 million in accounts receivable was at risk. Retained for accounts receivable management and recovery. Project consisted of clinical audit and billing review for accurate claim submission to Medicare.
Outcome:
- Uncovered serious regulatory and compliance violations causing us to invoke attorney client privileges and retain outside counsel to assist client with potential fraud and abuse issues
- Utilized audit outcome to create a staff education program regarding patient care issues, compliance, fraud and abuse, and documentation
- Audit outcome precipitated a process redesign and the re-engineering of operations
- Launched a new information system to support the agency's new processes
- Collected $57.8 million dollars
- Reduced Day Sales Outstanding (DSO) from over 270 days to 55 days
© 2002-2007 Acucare Group
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| NAHC Member | AHHIF Member | TAHC Member | AHHC Member |