Say the words “health care” and many listeners will envision antiseptic-smelling hospital towers and multi-specialty medical clinics with stadium-capacity parking lots.

But the reality is that a lot of health care is delivered outside these large-scale (and well-funded) settings. And with calls to control health care spending growing year by year, many observers think more health care will be directed to cheaper, nontraditional settings — especially the home.

However, another major problem in health care is billing fraud, especially for the federal Medicare program for seniors and the federal- and state-funded Medicaid program for lower-income residents. 

Auditors say that Medicare probably paid more than $52 billion in improper payments in 2017. And the proportion of improper payments in Medicare’s home health care program is believed to be particularly high, with an “error rate” of more than 50% in 2014.

Those are major reasons why, when Congress passed sweeping legislation in 2016 known as the 21st Century Cures Act to speed up medical innovation, lawmakers also included a provision requiring providers of home health care and personal care services to electronically verify their locations by phone or GPS. Rather than mandating a one-size-fits-all approach, Congress left it to each state to figure out how to have their providers meet the requirements for “electronic-visit verification,” beginning next year for some providers.

For small providers on tight budgets, this mandate could become one more technological hurdle, said Jamal Abdulahi, president and CEO of Minneapolis-based electronic health services firm FandF Health.

“We talk about home health care agencies — everyone would agree that the future of health care is in the home. But these are organizations that run on very thin margins,” Abdulahi said. “And they have been ignored simply because the margins to make a big technology solution isn’t perceived to be there.”

FandF Health Inc., headquartered just south of the West Bank campus of the University of Minnesota, was formed in 2017 with the intention of offering electronic services to health care entities including smaller providers that might have a hard time affording the costly services sold to big health care systems. Electronic-visit verification is one aspect of the service, which can be “bundled” with other digital offerings such as electronic billing and coding for medical and dental services, and automation of documentation services.

FandF’s electronic-visit verification system uses Google Maps to read the precise location of the home health provider’s phone at the start and the end of a visit, proving that the person was where they said they were for the prescribed amount of time. The system can also register a call from a landline phone in places where cell service is unavailable. Those entries, along with signatures of both the patient and provider, are permanently added to the medical record and billing system once entered.

Since the system uses Google’s technology to map providers’ locations, it gets the same level of protection against GPS “spoofing” as Google’s massive targeted-advertising program, Abdulahi said.

“It is intended for the small and midsize companies, as well as the community-based nonprimary care providers,” Abdulahi said. “Home health care agencies, adult day cares, assisted living centers — these are a vital element of our overall health care system. And they don’t have a big budget to invest in technology. But they are a vital part and they provide vital care services. So we provide them a cloud-based solution at a low cost.”

FandF Health has eight employees today, and close to 100 clients in Minnesota and Ohio, though more than half of those clients are still in the trial phase. The company has received grant funding from the Minnesota Department of Employment and Economic Development, or DEED, and has worked with advisers at the U on its business strategy. (The two initials in the company’s name stand for “friends and family.”)

Other companies offer similar services. Abdulahi said FandF tries to differentiate itself from the market by offering its services in a “bundled” package, similar to how an insurer might bundle the costs of home and vehicle insurance into one price, and also by emphasizing its customer service to smaller providers.

“The folks that we are pitching on our solution, they don’t really care about [having] the shiniest object in technology. Where they do care is problem solving,” Abdulahi said. They have practical questions like, “ ‘Is my claim going to be reimbursed on time, so I can make that payroll?’ For them to be delayed by a web-based solution that can get glitched up or have an erroneous process, it’s not a real option for them.”