“Amenity Consulting, LLC is a a subcontractor to Chase Consulting, LLC on the CMS Probable Fraud Measurement Pilot (PFMP). The program is designed to estimate the incidence of potential Home Health Care fraud in the Medicare fee-for-service program. The goal of the program is “to develop an approach to estimate the fraction of Medicare payments for home health services that exhibit behavior consistent with fraudulent activities, as determined by expert opinion informed by a review of records and interview information.” The pilot program’s purpose is to conduct a test of the procedures, interview instruments, and review methods for the project.

This pilot project consists of the following tasks: CMS training sessions for process, design and standard operating procedures of the PFMP followed by data mining to select claims with high probability of fraud. From that point our team accompanied by Fraud investigators will perform unannounced field (patient, HHA, and Provider) interviews, review medical records and medical documentation to conduct audits. The experts on this elite team will evaluate the methodologies used in the testing of theory and data mining. Then revise, re-engineer, or retest methodologies if necessary. The information gleaned through this pilot will be utilized by CMS in evaluation of future program integrity initiatives in the home health arena. “