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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-02-17-01025
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.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 were not confined to the home (homebound) or were not in need of skilled services.Our objective was to determine whether Visiting Nurse Association of Central Jersey Home Care and Hospice, Inc., (VNA of Central Jersey) complied with Medicare requirements for billing home health services on selected types of claims.

Report Type
Audit
Location

NJ
United States

Number of Recommendations
5
Questioned Costs
$2,015,925
Funds for Better Use
$0

Open Recommendations

This report has 3 open recommendations.
Recommendation Number Significant Recommendation Recommended Questioned Costs Recommended Funds for Better Use Additional Details
269644 No $0 $0

We recommend that VNA of Central Jersey for the remaining portion of the estimated $2,015,925 overpayment for claims 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

269645 No $0 $0

We recommend that VNA of Central Jersey 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

269643 No $2,009,804 $0

We recommend that VNA of Central Jersey refund to the Medicare program the portion of the estimated $2,015,925 overpayment for claims incorrectly billed that are within the 4-year reopening period.

Department of Health & Human Services OIG

United States