OIG Calls for Additional Oversight of Home Health, Personal Care Service Providers

In a new report released Monday, the U.S. Department of Health and Human Services Office of Inspector General (OIG) highlighted dozens of its unimplemented recommendations for reducing fraud, waste and abuse throughout the Medicare and Medicaid systems.

Many of the recommendations were tied to home health, hospice and personal care services, in addition to how Medicare Advantage (MA) plans operate.

OIG’s recommendations — 25 in total — come from several years of audits and evaluations, performed under the Inspector General Act of 1978.

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On the home health care front, OIG doubled down on its stance that the Centers for Medicare & Medicaid Services (CMS) should implement the statutory mandate requiring surety bonds for home health agencies that enroll in Medicare — and consider implementing the requirement for other providers as well.

CMS could have recovered at least $39 million in uncollected overpayments between 2007 and 2011 if it had required home health agencies to obtain $50,000 in surety bonds, according to OIG.

In fiscal year 2018, Medicare paid an estimated $3.2 billion in improper payments for home health services, though that figure has plummeted dramatically over the past several years. In general, improper payments are most commonly linked to improper documentation — not eligibility issues or intentional fraud. 

“While there’s more to be done, the work of CMS and the industry since 2015 now has us swiftly and aggressively moving in the right direction,” Amedisys Inc. (Nasdaq: AMED) CEO Paul Kusserow wrote in an April letter to the editor published by Home Health Care News.

When it comes to hospice, OIG reaffirmed its belief that CMS should seek statutory authority to establish additional remedies for hospices with poor performance. Currently, the agency’s primary means of recourse when a hospice is found to have serious deficiencies is to terminate the hospice from the Medicare program.

Failure to make home visits, failure to manage patients’ pain and maggots infesting a patient’s feeding tube were just a few of the safety deficiencies noted in a recent hospice report from OIG. Overall, about 20% of hospices surveyed by regulators or accreditors between 2012 and 2016 had a deficiency that posed a serious safety risk, OIG watchdogs found.

Meanwhile, OIG also called attention to its unimplemented recommendation that CMS requires states to either enroll personal care services (PCS) attendants as providers or require such attendants to register with their state Medicaid agencies, assigning each attendant a unique identifier.

“PCS are subject to persistent fraud and beneficiary harm,” OIG wrote in its Monday report. “Furthermore, OIG has raised concerns about the varying standards, and in some cases minimal vetting, for PCS attendants.”

Internally, CMS continues to discuss the feasibility of requiring unique identifiers for PCS attendants. Carrying out the recommendation may soon be a moot point, however, as the 21st Century Cures Act mandates that states implement an electronic visit verification (EVV) system for all Medicaid personal care service providers by Jan. 1, 2020. 

Along Medicare Advantage lines, OIG once again pointed out that CMS should require MA plans to include ordering and referring provider identifiers to their encounter data.

“Ordering and referring provider identifiers are not required in, and were frequently absent from, encounter data,” OIG wrote. “This limits the use of these data for vital program oversight and enforcement activities. It is important that quality of patient care can be tracked by National Provider Identifiers to assess whether ordering or referring providers have determined that services were appropriate for patients.”

CMS has made no progress on that particularly recommendation, according to OIG.

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