Former Medicare Prosecutors & Defense Counsel
Outcome and Assessment Information Set (OASIS) forms are mandatory standardized assessments used by home health agencies that participate in Medicare. OASIS forms collect information about a patient’s service requirements, functionality, and demographics. The information gathered on the OASIS form is used to create a patient-specific Plan of Care, or generally referred to as Form 485, and determine Medicare and Medicaid reimbursement. OASIS forms additionally help home care providers measure outcome-based quality improvement (OBQI). The criteria for the OASIS forms is determined by the Centers for Medicare and Medicaid Services (CMS) and is updated periodically.
Healthcare Fraud Defense Attorneys Explain the Need for OASIS Forms
The OASIS form is completed by a nurse or therapist providing home care to a patient. The home care provider should fill out the OASIS form based on direct observation of the patient and speak with the patient about his/her condition. An OASIS form must be filled out every 60 days in connection with re-certification for home health care. In addition, an OASIS form must also be filled out upon admission, discharge, or transfer from a home health service and upon any change in the patient’s condition. The information contained on a patient’s OASIS form determines how much a home health agency will be paid for caring for the patient. The OASIS form reports how many times a patient is visited each week, the type of care the patient receives, and the patient’s level of need.
OASIS Forms and Healthcare Fraud
Federal investigators, including the Health Care Fraud Prevention and Enforcement Team (HEAT) and local Medicare Fraud Strike Forces, are increasingly targeting healthcare fraud within the home health industry. One of the means by which investigators seek to identify and demonstrate home health fraud is by scrutinizing OASIS forms. Incorrect information on an OASIS form that causes a home health agency to receive an overpayment from Medicare or Medicaid would indicate healthcare fraud.
Home health agencies have committed healthcare fraud by exaggerating patient’s conditions on their OASIS forms to justify providing medically unnecessary services. Another common home health fraud scheme involves reporting a high number of patient visits per week on the OASIS form and then not actually visiting the patient or visiting the patient for only a fraction of the reported time of the visit.
Healthcare Fraud Prevention and Defense
The government officials at the Centers for Medicare and Medicaid (CMS) rely on the information contained in OASIS forms, and anyone filling out OASIS forms should make sure that the information provided is accurate and representative of the patient. However, sometimes even qualified healthcare providers make mistakes on OASIS forms.
At the The Criminal Defense Firm, we have seen nurses, therapists, and home health agencies come under investigation for healthcare fraud based on the information contained in OASIS forms. Our federal criminal defense attorneys understand that healthcare fraud requires the intent to commit fraud and that unintended mistakes do not amount to fraud under the law. Therefore, we strive to demonstrate to investigators and prosecutors that any inaccuracies presented in OASIS forms filled out by our clients were the result of unintentional mistakes and not the intent to commit fraud. Our top priority is avoiding criminal charges and convictions for our clients.
Free & Confidential Consultation
Federal prosecutors take allegations of healthcare fraud very serious, and so should you. If you are under investigation for healthcare fraud or have been charged in a healthcare fraud case, you need an experienced defense attorney who understands healthcare fraud defense. At The Criminal Defense Firm, many of our attorneys formerly served as federal healthcare prosecutors, and they use their experience to create proven strategies to defeat charges of healthcare fraud for our clients.
Call us today and speak to one of our experienced attorneys directly. We are available to discuss your situation in a free and confidential call, including on weekends.
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Dr. Nick Oberheiden is a national litigation and trial criminal defense attorney who practices exclusively in the area of federal law.