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Home Health Care Risk Management Part 1 – The Growth of Home Health Care

Home Healthcare Commercial Insurance

Home health care is defined as skilled nursing care and certain other health care services that you get in your home for the treatment of an illness or injury. At last count, there were 12,445 Medicare-certified home health agencies and 20,660 other home care companies in the United States. Indeed, home health care is the fastest growing sector in the industry serving those who require elderly health care. This is due to a number of reasons:

  • The enactment of Medicare in 1965
  • The 1987 revisions to Medicare, which introduced reimbursement to home care agencies
  • The continual growth of our aging population
  • The increased life expectancy of seniors
  • The willingness to decrease the length of hospital stays and provide early discharge of many patients to home care

Classification of Home Care Agencies

Freestanding proprietary agencies provide most formal home care. Home care is also provided by hospital-based agencies, with nonprofit public and private health agencies providing a smaller portion. There are three major classifications of home health care agencies:

Home Health Care Risk Management Part 2 – Risk Associated with Home Health Care

Home Healthcare Commercial Insurance

Home health care provides some unique challenges for those working in this environment. Not only are many of the same risks associated with hospitals and nursing homes present, but household related hazards such as poor air quality, toxic substances, and aggressive pets may also be issues. Additionally, the homecare health setting cannot be controlled. Finally, many home health care providers may have limited training and experience in providing patient safety and there is no direct supervision of their daily activities.

Some of the risks associated with home health care are:

General security/personal safety hazards:

  • Unsafe neighborhoods
  • Violence from patients or family members
  • Potentially dangerous household pets

Home Healthcare – At Risk for Fraud and Theft

Home Healthcare Risk Management Insurance

When it comes to home healthcare, fraud and theft are major areas of concern. Every effort must be made to prevent fraud and theft, as occurrences not only affect the well-being of patients, but can also harm a client’s reputation.

Health care fraud occurs when false information is represented as truth. Perpetrators exploit patients by entering into their medical records false diagnoses of medical conditions they do not have, or of more severe conditions than they actually do have. Then bogus insurance claims can be submitted for payment.

Home healthcare fraud claims also involve intentional incorrect billing of Medicare. According to the Senior Medicare Patrol (SMP), “An estimated $250 million is lost to purposeful health care fraud each year.” Examples of fraud that may occur include:

Managing the Unique Risks of Hospice Care

Hospice Care

Volunteers are a necessity in a successful hospice program. With this realization, Federal regulations actually require a specific level of volunteer activity at each hospice receiving Medicare and Medicaid funding. Although these dedicated and caring volunteers are important assets to a successful hospice program, they provide a unique area of risk management.

Liability Issues

In addition to the liability for the acts and omissions of employees, hospices are also liable for acts and omissions of its volunteers. Not only does this liability affect the willingness of hospices to use volunteers, but also volunteers might be reluctant to assume liability. Fortunately, the Federal Volunteer Protection Act of 1997 promoted the idea of volunteer participation by attempting to immunize volunteers at charitable and nonprofit organizations from liability for their acts and omissions if performed within their volunteer duties. The requirements of the act are:

  • If appropriate or required, the volunteer must have been properly licensed, certified, or authorized by the appropriate authorities in the state in which the harm occurred.
  • The harm was not caused by the volunteer operating a motor vehicle for which the state requires the operator to possess an operator's license or maintain insurance.
  • The harm was not caused by willful or criminal misconduct, gross negligence, reckless misconduct, or a conscious, flagrant indifference to the rights or safety of the individual harmed by the volunteer.
  • The volunteer must have been acting within the scope of his or her responsibilities when the act or omission occurred.

However, the statute does not apply to misconduct which:

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