Office of Inspector General Releases FY 2017 Work Plan for Home Health

PUBLISHED: Nov 22, 2016

The U.S. Department of Health and Human Services Office of Inspector General (OIG) issued its Work Plan for fiscal year (FY) 2017 summarizing new and ongoing reviews and activities that OIG plans to pursue with respect to HHS programs and operations during the current fiscal year and beyond. Today’s StayAlert! Notice reviews those aspects of the Work Plan specific to home health

Below is a summary of some of the areas that OIG will focus on for home health in 2017. See the OIG’s 2017 Work Plan for a complete listing of focus areas.

Home Health Services

  • NEW: Comparing HHA Survey Documents to Medicare Claims Data:
  • Previous OIG work has shown that the home health program is prone to fraud, waste, and abuse. OIG will determine whether HHAs are accurately providing patient information to State agencies for recertification surveys.
  • Home Health Compliance with Medicare Requirements:
  • The Medicare home health benefit covers intermittent skilled nursing care, physical therapy, speech language pathology services, continued occupational services, medical social worker services, and home health aide services. For CY 2014, Medicare paid home health agencies (HHAs) about $18 billion for home health services. CMS’s Comprehensive Error Rate Testing (CERT) program determined that the 2014 improper payment error rate for home health claims was 51.4 percent, or about $9.4 billion. Recent OIG reports have similarly disclosed high error rates at individual HHAs. Improper payments identified in these OIG reports consisted primarily of beneficiaries who were not homebound or who did not require skilled services. OIG will review compliance with various aspects of the home health prospective payment system and include medical review of the documentation required in support of the claims paid by Medicare. OIG will determine whether home health claims were paid in accordance with Federal requirements.

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