Part I: How Geotagged EVV Check-In Data Can Get Wired Into Medicaid and Medicare Managed Care Claim Edits to Reject Home Health Fraud at Submission and Break the Decade-Long Federal Moratorium Loop

CMS just reimposed a nationwide home health agency moratorium. LA County has 12-15% of all HHAs while holding 3% of Medicare beneficiaries. Ohio found 18 agencies at one address. The pay-and-chase loop is running again.Here is the absurd part. GPS-verified visit data is already being collected at every Medicaid home health visit under the 21st Century Cures Act mandate. Six data elements, including location, captured at the moment of service.That data sits in aggregator databases. It gets used for post-pay audits. It does not feed into the claim adjudication engine before payment goes out the door. The NPI is valid, the auth is on file, the money moves.The gap between EVV data and claim adjudication is not primarily a technology problem. The 837P transaction already has room for a verification ID at the service line level. Sub-500ms API match on six elements is production-ready today.Subscribe to www.onhealthcare.tech for free and paid articles, podcasts, and more. This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit www.onhealthcare.tech/subscribe