Home Health & Hospice Week

Audited HHA blasts OIG for contracting out its claims review.

A federal watchdog agency continues to wield its extrapolation sword to cut into a home health agency’s payments.

In a new report, the HHS Office of Inspector General recounts a 100-claim audit for Great Lakes Home Health Services Inc. in Jackson, Michigan. A reviewer contracted by the OIG originally found 59 claims to be erroneous. But when the agency disputed the findings, the reviewer removed the determination for 21 of those claims and adjusted the findings for nine others, the OIG says in the report.

Taking back some of the error determi­nations is the same pattern found in three recent reports for other audited HHAs (see Eli’s HCW, Vol. XXVIII, No. 20).

The OIG claims that Great Lakes incorrectly billed Medicare for beneficiaries who were not homebound and did not require skilled services. For the 38 remaining claims it found in error, Medicare paid Great Lakes about $64,000 in 2014 and 2015.Extrapolated to the agency’s universe of claims for those years, the OIG estimates Great Lakes received $10.5 million in overpayments.

Burn: In its lengthy response letter, Great Lakes upbraids the OIG for using a contractor to conduct the claims reviews. “Had the OIG performed the audit using its own staff rather than an outside contractor, the results of the audit would be much more accurate,” the agency contends in the letter. Great Lakes’ counsel at Greenberg Traurig point out in the letter that the draft report on which it commented contained “numerous and significant legal and factual errors.”

Great Lakes joined with National Home Health Care and Jordan Health Services earlier this year to form Elara Caring, which now has 225 locations in 16 states.

Note: The report is at https://oig.hhs.gov/oas/reports/region5/51600057.pdf.