Medicare Home Health Agency Provider Compliance Audit: Condado Home Care Program, Inc.

Submitting OIG:

Department of Health & Human Services OIG

Report Description:

Under the Medicare home health prospective payment system (PPS), the Centers for Medicare & Medicaid Services pays home health agencies (HHAs) a standardized payment for each 60-day episode of care that a beneficiary receives. The PPS payment covers intermittent skilled nursing and home health aide visits, therapy (physical, occupational, and speech-language pathology), medical social services, and medical supplies.

Date Issued:

Monday, August 10, 2020

Agency Reviewed / Investigated:

Department of Health & Human Services

Submitting OIG-Specific Report Number:

A-02-17-01022

Component, if applicable:

Centers for Medicare & Medicaid Services

External entity, if applicable:

Condado Home Care Program, Inc.

Location(s):

San Juan, PR

United States

Type of Report:

Audit

Questioned Costs:

$97,210

Number of Recommendations:

View Document:

Attachment	Size
A-02-17-01022.pdf	2.32 MB

Additional Details Link:

https://oig.hhs.gov/oas/reports/region2/21701022.asp

Recommendation Number	Recommendation Status	Significant Recommendation
269186	Open	No
We recommend that Condado Home Care Program, Inc. refund to the Medicare program the portion of the estimated $97,210 in overpayments for claims incorrectly billed that are within the 4-year claim reopening period.
269187	Open	No
We recommend that Condado Home Care Program, Inc., based upon the results of this audit, exercise reasonable diligence to identify, report, and return any overpayments in accordance with the 60-day rule, and identify any of those returned overpayments as having been made in accordance with this recommendation.
269188	Open	No
We recommend that Condado Home Care Program, Inc., for the remaining portion of the estimated $97,210 in overpayments that are outside of the Medicare reopening period, exercise reasonable diligence to identify and return overpayments in accordance with the 60-day rule and identify any returned overpayments as having been made in accordance with this recommendation.
269189	Open	No
We recommend that Condado Home Care Program, Inc. strengthen its procedures to ensure that: - the homebound status of Medicare beneficiaries are verified and continually monitored and the specific factors qualifying beneficiaries as homebound are documented; - beneficiaries are receiving only reasonable and necessary skilled services; - home health episodes are billed correctly; and - plans of care comply with Medicare requirements.

Recommendation Number

Recommendation Status

Significant Recommendation

Additional Details

269186

Open

We recommend that Condado Home Care Program, Inc. refund to the Medicare program the portion of the estimated $97,210 in overpayments for claims incorrectly billed that are within the 4-year claim reopening period.

269187

Open

We recommend that Condado Home Care Program, Inc., based upon the results of this audit, exercise reasonable diligence to identify, report, and return any overpayments in accordance with the 60-day rule, and identify any of those returned overpayments as having been made in accordance with this recommendation.

269188

Open