Amedisys has a robust compliance program that represents the principles and rules guiding the care we provide. Our compliance program is designed to conform with the Office of the Inspector General's Model Compliance Program guidelines for home health and hospice. We promote accuracy and integrity in all aspects of our company, whether administrative, clerical, clinical or financial.
Prevention and Education
The best way to fight fraudulent activity is to prevent it. We communicate clear standards and expectations for employee activities, and require periodic, mandatory compliance training for all employees. Compliance is a consistent focus at Amedisys, with employees trained upon hire, as regulations change, and re-trained at least annually to reinforce compliance standards.
Knowledge and adherence to our compliance standards is expected of all Amedisys employees, and any employee with questions or concerns is encouraged to seek guidance from their supervisor, the compliance staff, or through our 24/7 compliance hotline (1-800-464-0020).
Technology
We infuse the same technology that drives our operations into our organization's compliance infrastructure. First and foremost, our point of care system improves the accuracy, consistency and completeness of our documentation. In addition, we developed an automated compliance scorecard that helps us identify agencies that are more susceptible to compliance problems based on approximately 30 different risk metrics. This compliance scorecard drives the proactive audits that we undertake.
Detailed Monitoring
Amedisys engages in frequent review of company activities to confirm compliance with all laws and regulations. Our compliance department is staffed with a team of clinical auditors who are independent of our operations division. They conduct clinical audits every day to assess all aspects of our compliance, including documentation of services provided, medical necessity, patient eligibility and coding.
In addition, other departments within Amedisys also play a key role in assessing and ensuring our compliance. Such reviews include care center assessments, clinical operations audits, conditions of participation audits, internal audits, Sarbanes Oxley audits, and annual external audits of consolidated financial statements for the company. Further, we perform periodic medical records reviews throughout the year to ensure ongoing adherence to the Conditions of Participation, Medicare coverage and eligibility guidelines, and compliance with other regulations.
To help identify and prevent compliance issues, we integrated automatic coding reviews into our patient record technology, which flag certain coding patterns for further review by a team of experts. We also contact a random sample of 130 active employees each month for a confidential phone interview with the Compliance department, and conduct an exit survey of all employees who leave the company.
Zero Tolerance
Simply put, Amedisys maintains a position of zero tolerance when it comes to fraud, both for those directly violating compliance standards and those who fail to report or investigate suspected violations.
Anti-Fraud Reform
Health care fraud is a crime that affects providers, physicians, taxpayers and most worryingly, patients’ access to care. As an industry leader, Amedisys takes a strong stance against fraud, waste and abuse.
In home health care, a relatively few unscrupulous individuals commit the vast majority of fraud and there are commonsense steps Congress can implement to eliminate these abuses. We staunchly support the Partnership for Home Healthcare’s proposed anti-fraud reforms, which would save taxpayers as much as $700 million per year without impacting patients’ access to care.
We encourage you to visit act.homehealth4america.org to learn more and support this important reform.