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Fraud Prevention

Did you know?

The penalties for determination of Medicaid fraud for a single given session includes $11,500 per session + double the reimbursement received for the session (for situations listed below), as well as the government’s legal fees.

Understanding Fraud Prevention:

The possibility of potential allegations is nightmarish for most agency directors, given the likely misinterpretation of inadvertent:

 
  • Zero travel time between sessions
  • Overlapping sessions
  • Back to back sessions (in different homes)
  • Too little travel time between sessions

The best case scenario is one in which the therapist in question treated a non-Medicaid eligible child, resulting in the recoupment of fees paid for the sessions in question. If overlapping or zero travel time occurred with respect to two children, recoupment of funds paid occurs for both children, irrespective of whether services actually occurred, in accordance with early intervention regulations. Considering that early intervention is an ever skyrocketing government expense, it is no wonder that government regulators are expending efforts toward recoupment of funds because of inadvertent error, or worse – because of Fraud.

Occurrences of this type have happened throughout the Country, in many cases resulting in arrests, fines, and prison time. (See adobe articles on fraud)

Our Solution:

EISS provides a patent pending cross-referencing web-based cartographic mapping filtering dual module that checks all therapists in your database for possible overlapping sessions, back-to-back sessions (indicating zero travel time – unless, for example, both children lived in the same home). Inadvertent therapist error can be detected, and notes mailed back to therapists so that may make corrections. Our software allows the owners and directors of early intervention programs to rest easy and worry free of possible allegations of fraud.

Enjoy the peace of mind which accompanies our unique automated fiscal audit for every billing submission- prior to submission. Our patent-pending module allows unparalleled prevention and detection of what may be inadvertent error, or outright fraud, allowing you to identify and legally redress this matter, prior to billing.

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