OIG report: One in every five HH claims has errors
Yet another report released by the Department of Health and Human Services’ Office of the Inspector General (OIG) scolds home health agencies. The latest finding by the OIG shows a 19% error rate in home health claims in four major states: California, Illinois, New York, and Texas.
The release of the findings prompted a strong response from the home health industry, accusing the OIG of being politically motivated.
Nearly one in five claims were improper
The report contends that nearly one in five claims submitted in those four states during a nine-month period in 1998 were improper or highly questionable and did not meet Medicare reimbursement requirements. "The scope of these audits went well beyond our usual level of effort, and the industry has complained that this level of audit resulted in a higher level of disallowances than ordinarily would be the case," said Mike Hash, deputy administrator for the Health Care Financing Administration (HCFA), in the report.
While the OIG’s latest estimate seems high, it is a drastic reduction from its original estimate for the same four states. In an earlier audit, OIG investigators determined that 40% of services did not meet Medicare reimbursement requirements. "Our current review found the error rate in home health claims has been significantly reduced, but remains way too high," auditors wrote in the report.
OIG officials blamed the majority of unallowable services on inadequate physician involvement. It found that many physicians did not actively participate in the plans of care they signed. The OIG put the total of erred claims paid in those four states at $675.4 million.
The OIG recommended that HCFA revise Medicare regulations to require the certifying physicians to examine the patient before ordering home health services, see the patient at least once every 60 days, and instruct the intermediaries to collect overpayments identified in its sample.
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