Home Health

OIG audit questions full episodes for limited services

The latest home health agency audit by the Department of Health and Human Services Office of Inspector General (OIG) highlights a frequent topic for OIG reviews: questioning the need for homebound services mid-episode.

OIG claimed that 17 of the 100 claims it reviewed from Catholic Home Care were incorrectly billed. Sixteen of those claims were allegedly incorrectly billed for a portion of the episode because the patient “did not meet the Medicare requirements for coverage of skilled nursing or therapy services,” according to the report.

In one example, OIG claimed that a beneficiary recovering from hip replacement surgery needed physical therapy rehabilitation and a skilled services nursing assessment following the surgery. “However, the medical records did not support that the beneficiary required skilled nursing services after the initial assessment,” according to the OIG report.

Based on its findings, OIG suggested that the agency received more than $4.2 million in overpayments between 2017 and 2018. In response, Catholic Home Care argued that OIG’s determinations did not conform with current case law, Medicare standards and guidelines or clinical facts in the medical records.

Read the full report.