OIG Report Finds Most Inappropriate Home Health Billing in Texas, Florida, California, Michigan

A report recently released by the Office of Inspector General found that in 2010, Medicare inappropriately paid $5 million for home health claims with three specific errors: overlapping with claims for inpatient hospital stays, overlapping with claims for skilled nursing facilities or billing for services on dates after beneficiaries' deaths.

The study also showed that one in four home health agencies exceeded the threshold that indicated unusually high billing for at least one out of six measures of questionable billing.

Of the inappropriate or questionable billing found by the OIG, 80% of the home health agencies identified were located in four states: Texas, Florida, California and Michigan, which represented 47% of the total number of home health agencies in 2010.

In its report, the OIG makes several recommendations to CMS:

• Consider imposing a temporary moratorium on new agency enrollments in Florida and Texas;
• Implement claims processing edits or improve existing edits to prevent inappropriate payments for the three specific errors reviewed;
• Increase monitoring of billing for home health services;
• Enforce and consider lowering the 10% cap on the total outlier payments an agency may receive annually; and
• Take appropriate action regarding the inappropriate payments identified and agencies with questionable billing.

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