Medicare Home Health Agency Provider Compliance Audit: Caretenders of Jacksonville, LLC

Under the 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.Our prior audits of home health services identified significant overpayments to HHAs. These overpayments were largely the result of HHAs improperly billing for services to beneficiaries who either were not confined to home (homebound) or were not in need of skilled services.Our objective was to determine whether Caretenders of Jacksonville, LLC (Caretenders), complied with Medicare requirements for billing home health services on selected types of claims.