OIG Report Highlights Personal Care’s Outsized Role In Medicaid Fraud

As at-home care has increasingly become a more popular model for health care, a significant portion of fraud convictions over the last 10 years have involved personal care services attendants. Between 2014 and 2023, personal care services accounted for at least 34% of fraud convictions in some years and as much as 48% in other […]

How The Rural Add-On Payments Changed Where Home Health Services Were Delivered

Utilization of home health services fell in both urban and rural counties from January 2016 to March 2022 in the “high-utilization” categories, in part, due to the rural add-on payments. In 2018, the Centers for Medicare & Medicaid Services (CMS) implemented a rural add-on payment, or a percentage increase, at the request of Congress. That […]

Why OIG Telehealth Fraud Findings May Mean Further Roadblocks For Home Health

A number of health care providers that billed Medicare for telehealth services likely did so in a fraudulent or wasteful manner, according to federal watchdogs. That finding and others like it dampen the chances of home health providers being able to bill for virtual care moving forward. That’s one major takeaway from a recent report […]

What Home Health Providers Can Learn from Hospice OIG Audits

The home health industry should keep its collective eye on the U.S. Department of Health & Human Services Office of the Inspector General’s (HHS-OIG) recent audits on the hospice industry, because it soon could be next. As the home health space continues to grow, federal oversight and the scrutiny attached to the industry have grown […]

A ‘Persistence of Patient Harm’: Hospital Failures Highlight Need for Home-Based Care Investments

The traditional brick-and-mortar hospital system is broken, often leaving patients in a condition that’s worse than when they first arrived. That’s according to a May report from the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG). The findings throw further support for facility-based care alternatives, including the types of hospital-at-home models […]

Rural Access to Home Health Services, PACE Among Lawmakers’ Future Spending Priorities

U.S. lawmakers have repeatedly highlighted a need to rethink the nation’s long-term care landscape in recent months, partly in response to the COVID-19 pandemic but also because of the country’s rapidly changing demographics. A recently published budget report from the House Appropriations Committee obtained by Home Health Care News offers further insight into that call […]

OIG: CMS Could Have Saved $192M with Stronger LUPA Oversight

Federal watchdogs are once again setting their sights on perceived improper billing practices by home health agencies. In an audit report published last week, the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) found that stronger oversight of Low Utilization Payment Adjustments (LUPAs) in home health care could have saved […]

OIG: Iowa Overpaid Medicaid-Reimbursed Home Health Providers by $37.1M

The state of Iowa did not sufficiently monitor its health home care program providers for at least four years, resulting in tens of millions of dollars in improper reimbursement, the Office of Inspector General (OIG) found upon review.  The Medicaid health home care option allows states flexibility in creating programs that produce care coordination and […]

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 […]