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 […]

CMS: No ‘Secret List’ of Troubled Home Health Agencies

Earlier this week, a bipartisan pair of U.S. senators released a “secret list” of nursing homes under consideration for placement on the federal government’s roster of properties with serious quality issues. Maintained by the Centers for Medicare & Medicaid Services (CMS), the list features more than 400 nursing homes that are “candidates” for the Special […]

Artificial Intelligence Holds Promise in Detecting Home Health Medicare Fraud

A study on artificial intelligence (AI) suggests the technology holds promise for detecting Medicare fraud within home health and hospice. However, leaders within the industry say a measured approach should be taken, given potential shortcomings and pitfalls related to AI. The research team at Florida Atlantic University programmed computers to predict, classify and flag potentially […]

OIG Special Agents Sound Off on Hospice Fraud, CMS Rules

In one example of hospice fraud, a provider was caught billing for 17 days of general inpatient care for a 70-year-old Medicare beneficiary, though a caregiver had never even visited him. In another case, an owner a hospice was found to be using recruiters to solicit and enroll beneficiaries for hospice care when they were […]

OIG Issues Sweeping Report on Hospice Fraud and Care Quality Concerns

To counter claims of fraud and abuse in the hospice industry, federal regulators have loudly announced their plans to aggressively go after dishonest providers. Those watchdogs include the U.S. Department of Health & Human Services’ Office of Inspector General (OIG), which released a sharp new report on fraud vulnerabilities within the Medicare hospice program on […]

New York Overbilled Medicaid Home Care Program by $75 Million

New York’s Medicaid agency claimed reimbursement for some in-home care services that were not in accordance with Medicaid requirements, to the tune of $74.8 million, according to the Office of Inspector General. The state did not provide documentation of services claimed, claimed reimbursement for services that were not authorized or supported, and for claims which […]

Fraud Watch: Miami Home Health Owners Indicted in Scheme

Three Miami Home Health Agency Owners Charged in Fraud Scheme Three Miami-area home health care agency owners were charged in an indictment for their alleged participation in a health care fraud scheme involving a now-defunct business, the Department of Justice (DOJ) announced in March. Ailin Consuelo Rodriguez Sigler, 39; Ziola C. Rios, 57; and Thomas […]