Home Health & Hospice Week

One-third of determinations reversed after rebuttal.

A for-profit Miami home health agency is the latest to see its OIG audit findings aired publicly.

After a contracted auditor reviewed 100 claims from 2015 and 2016 submitted by The Palace at Home, the HHS Office of Inspector General determined the agency “did not comply with Medicare billing requirements for 20 of the 100 home health claims that we audited. For these claims, The Palace received overpayments of $30,387.”

Based on that overpayment amount, the OIG determined The Palace owed “at least $731,304 for our audit period.”

The OIG contractor originally deemed 32 of the claims paid in error. But after The Palace pointed out flaws with the review, the OIG brought that number down to 20, the report says.

The Palace maintains those claims are valid. For example, “there is detail[ed], documented proof throughout these patient records that support the homebound status of these patients throughout the episode of care,” says Melinda Gaboury with Healthcare Provider Solutions, on behalf of the agency, in its response letter.

Note: The audit report is at https://oig.hhs.gov/oas/reports/region4/41707067.pdf.