Integrity One

The TAHC&H Integrity One Program promotes high standards of ethics, integrity, and accountability for the home care and hospice industry through TAHC&H member information, education and participatory programs. The Integrity One Program includes three (3) sections highlighted by the TAHC&H Anti-Referral and Anti-Kickback Laws Guide for Home Health Agencies and Hospices Operating in Texas.  Additional information and reporting resources on how to maintain accountability and avoid fraud and abuse issues in services and operations are also listed below.

Licensed Home and Community Support Services agencies are encouraged to become familiar with these information and reporting resources. 

REPORT FRAUD, WASTE OR ABUSE

• U.S. HHS – Office of Inspector General
• Texas HHS – Inspector General

INFORMATION & RESOURCES

• Anti-Referral and Anti-Kickback Laws: A Guide for Home Health Agencies and Hospices Operating in Texas – Valuable guide  intended  only  as  an  overview  of  certain  applicable  federal  and  Texas  laws.
• CMS Center for Program Integrity – Resources and Center for Program Integrity (CPI) Initiatives for providers types, State and partners.
• CMS Medicaid Program Integrity Education
• CMS Hospice  - Fact sheets and brochures intended as educational tools for providers, beneficiaries, and other stakeholders about Medicaid hospice benefits including fraud detection and reporting.
• CMS Personal Care Services (PCS) - This page contains an overview of PCS and common payment issues.
• CMS Documentation Matters Toolkit – A toolkit designed to serve as guidance for the medical professionals in the business of helping their patients while complying with Federal and State laws.
• CMS False Claims Act (Medicare and Medicaid)
• CMS Laws Against Health Care Fraud Guide – This guide gives an overview of some of the major Federal laws, including the False Claims Act and Anti-Kickback Statute.
• Texas False Claims Act Statue - Texas FCA Damages and Penalties.
• U.S. HHS Office of Inspector General (OIG ) - Online Portfolio: Home Health  -This Online Portfolio pulls together the OIG’s body of work, including enforcement actions, reports, recommendations and more, as it relates to the home health industry. The portfolio will be updated periodically.
• U.S. HHS Office of Inspector General (OIG ) – Compliance Resource Portal – Toolkits, provide compliance resources, training and advisory opinion letters, safe harbor regulations and much more.
• U.S. HHS Office of Inspector General (OIG ) - Enforcement Actions - View latest criminal and civil enforcement actions related to the U.S. HHS, OIG's investigative and legal work.

EXCLUSIONS DATABASE

• Texas HHS - Exclusions Database
• U.S HHS - Exclusions Program & Database

• Advisory Opinion No. 06-01(regarding a home health agency’s practice of providing prospective customers with a free preoperative home safety assessment).

• Advisory Opinion No. 07-08(regarding concerning a durable medical equipment supplier’s proposed arrangement to provide patients with a free in-home congestive heart failure assessment).

• Advisory Opinion No. 03-4(regarding a proposed program by a provider of home health care services to provide free medical-alert pagers and pager monitoring service to homebound patients during the period such patients are receiving the company's home health services).

• Advisory Opinion No. 01-20(regarding a payment arrangement between a Medicare-certified hospice and certain nursing facilities for services provided to residents of such facilities who are eligible both for Medicaid and Medicare hospice benefits ["Dually Eligible"]).