Home Health Agencies Receive $432 Million of Improper Medicare Payments

Home health agencies submitted 22% of Medicare claims in error in 2008, often due to being coded inaccurately, an Office of the Inspector General report on Medicare home health claims revealed in March.

The inaccurate or inaccurately coded claims led to more than $432 million in improper payment, the report states, representing about 2.5% of the total $17 billion in Medicare home health payments in 2008.

“Identifying home health fraud and abuse is a significant challenge that requires concentrated and sustained efforts using a variety of methods.” OIG states. “Given the general concern about risks to the Medicare program in the home health area, further investigations beyond the medical record are needed to determine whether beneficiaries are eligible, services are furnished, and Medicare requirements for payment are met.”

Home health agencies submitted 22% of claims in error because services were not medically necessary or claims were coded inaccurately, the report shows, and upcoded and downcoded each about 10% claims.

The home health care industry, which has grown to include 9,801 agencies by OIG’s count, is an an increased risk for fraud, other studies and investigations have found. While just 2% of claims were made for services that were not medically necessary, the office says it will continue to study and monitor home health claims in the quickly growing home health field.

“The Office of Inspector General will continue to monitor Medicare home health claims to determine whether the services are appropriate and merit payment,” the report states.

View the full report.

Written by Elizabeth Ecker

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Elizabeth Ecker
Director of Content at Home Health Care News
Curious about all things, when not writing about senior housing topics, Liz is an avid explorer of food. She loves trying new recipes, new restaurants and new ice cream flavors. (Current favorite: Goat cheese with red cherries.)



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