Home Health VNA (the Agency) (located in Lawrence, Massachusetts) did not comply with Medicare billing requirements for 105 of the 497 home health claims we reviewed. As a result, the Agency received net overpayments of $314,000 for calendar years 2011 and 2012. Specifically, the Agency incorrectly billed Medicare because beneficiaries were not homebound, beneficiaries did not require skilled services, documentation from the certifying physicians was missing or insufficient to support the services the Agency provided, or, in one instance, a claim contained an incorrect payment code. These errors occurred primarily because the Agency did not have adequate controls to prevent the incorrect billing of Medicare claims within selected risk areas.
MA
United States
