OIG to Target Home Health Billing Practices

A federal watchdog is planning to take a deeper look at home health billing practices nationwide.

Specifically, the U.S. Department of Health & Human Services Office of Inspector General (OIG) recently announced it intends to identify the common characteristics of “at-risk” home health agencies using data from the Centers for Medicare & Medicaid Services’ (CMS) Comprehensive Error Rate Testing (CERT) program. These characteristics, according to OIG, could be leveraged to target pre- and post-payment review of Medicare claims.

Medicare paid home health agencies approximately $18.2 billion for home health services in 2016, HHS noted. The CERT program, however, found that the 2016 improper payment error rate for home health claims totaled 42%, or approximately $7.7 billion.


Additionally, OIG plans to evaluate Medicare Part A payments to home health agencies to determine whether claims billed to Medicare Part B for services and items were permissible and in accord with federal regulations. Usually, certain supplies, items and services provided to inpatients are covered under Part A and should not be separately billable to Part B.

The agency disclosed this information in an update to its work plan.

Written by Mary Kate Nelson


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