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Report File
Date Issued
Submitting OIG
Department of Health & Human Services OIG
Other Participating OIGs
Department of Health & Human Services OIG
Agencies Reviewed/Investigated
Department of Health & Human Services
Report Number
A-05-16-00063
Report Description

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.

Report Type
Audit
Agency Wide
Yes
Number of Recommendations
3
Questioned Costs
$0
Funds for Better Use
$0
Additional Details
https://oig.hhs.gov/oas/reports/region5/51600063.asp

Open Recommendations

This report has 3 open recommendations.
Recommendation Number Significant Recommendation Recommended Questioned Costs Recommended Funds for Better Use Additional Details
268623 No $0 $0

We recommend that Residential Home Health for the estimated $2,068,902 overpayment for claims that are outside of the Medicare reopening period, exercise reasonable diligence in identifying and returning overpayments in accordance with the 60-day rule, and identify any returned overpayments as having been made in accordance with this recommendation.

268624 No $0 $0

We recommend that Residential Home Health exercise reasonable diligence to identify and return any additional similar overpayments outside of our audit period, in accordance with the 60-day rule, and identify any returned overpayments as having been made in accordance with this recommendation.

268625 No $0 $0

We recommend that Residential Home Health strengthen its procedures to ensure that the homebound statuses of Medicare beneficiaries are verified and continually monitored and the specific factors qualifying beneficiaries as homebound are documented and beneficiaries are receiving only reasonable and necessary skilled services.

Department of Health & Human Services OIG

United States