Federal Reports

A hotline complaint alleged that the director of an AmeriCorps program in Iowa misappropriated program funds to purchase groceries for her personal use.

Home health has long been recognized as a program area vulnerable to fraud, waste, and abuse. OIG home health investigations have resulted in more than 350 criminal and civil actions and over $975 million in receivables for fiscal years 2011-2015. Additionally, previous reports from OIG and the Government Accountability Office have raised concerns about questionable billing patterns, compliance problems, and improper payments in home health.

International Institute of Sleep, Inc. (the Institute), an Independent Diagnostic Testing Facility based in Deerfield Beach, Florida, billed Medicare for polysomnography services that did not meet Medicare billing requirements for all 100 randomly selected beneficiaries with 130 corresponding lines of service, resulting in overpayments of $78,000. These errors occurred primarily because the Institute did not have adequate controls to ensure that it properly documented polysomnography services billed to Medicare. On the basis of our sample results, we estimated that the Institute received overpayments of at least $1 million for the audit period.