HRS Home Health received overpayments of at least $100,696, according to a recent audit report from the Office of Inspector General (OIG).

The results come from a series of home health audits that looked into how agencies complied with Medicare requirements. HRS Home Health is one of the agencies that was audited.

Lombard, Illinois-based HRS Home Health is a for-profit home health agency. The company’s Medicare Administrative Contractor, Palmetto GBA, paid HRS Home Health $35 million for 18,422 claims for services provided to Medicare enrollees in 2020 and 2021. 

The Centers for Medicare & Medicaid Services (CMS) found that home health agencies had a 7.7% improper payment error rate for claims in 2023, amounting to roughly $1.2 billion. This was one of the reasons OIG decided to conduct its audits.

Overall, OIG reviewed a random sample of 100 home health claims with payments totaling $227,528.

“We evaluated these claims for compliance with selected billing requirements and submitted these claims to independent medical review to determine whether the services met coverage, medical necessity, and coding requirements,” OIG wrote in the report.

In 2023, home health agencies received about $16 billion in Medicare payments for care services delivered to 2.8 million people. Almost 10,000 home health agencies participated in Medicare that year.

OIG found that 80 of the 100 home health claims the organization reviewed complied with Medicare billing requirements. The 20 home health claims that were billed incorrectly either didn’t meet billing and coding requirements, didn’t meet plan of care requirements, or didn’t meet skilled need requirements.

OIG made a series of recommendations for HRS Home Health. The organization recommended that OIG refund the $100,696 in overpayments to the Medicare program.

OIG also suggested that HRS Home Health should conduct one or more internal audits or investigations to identify any similar overpayments and return the funds to the Medicare program.

OIG also called for HRS Home Health to enhance its review of medical record documentation to make sure it’s in compliance with Medicare billing requirements.

While HRS Home Health agreed to make repayments for seven of the claims, the company pushed back the full $100,696.

“HRS Home Health did not concur with the recommendation to repay the estimated overpayment amount of $100,696,” OIG wrote. “HRS Home Health disputed our decision to extrapolate because it believes that: ‘The 1% payment error rate derived from the OIG’s review cannot reasonably be characterized as the ‘sustained or high level of payment error’ necessary to justify extrapolation’ and ‘the OIG’s extrapolated overpayment amount is statistically invalid because [our] precision percentage of 68.22% exceeds the maximum precision percentage found by federal courts to be acceptable.’”