Home Health & Hospice Week

Wondering whether the OIG collects on its audits and investigations? A new report answers that question, to the tune of tens of billions of dollars.

In its latest Semiannual Report to Congress, which covers HHS Office of Inspector General activity for fiscal year 2010, the OIG recovered $25.9 billion, which included $1.1 billion in audit receivables.

"Along with our significant work related to a variety of HHS agency programs during this reporting period, we are particularly encouraged by the success of our partnerships with HHS and the Department of Justice through the Health Care Fraud Prevention and Enforcement Action Team (HEAT)," Inspector General Daniel R. Levinson says in a release. "For example, our HEAT Strike Force teams yielded 89 convictions and $71.3 million in investigative receivables in the second half of FY 2010 alone."

The OIG highlighted these home care areas in its report:

• Missing NPIs. The OIG chastises CMS for continuing to allow durable medical equipment providers to use their own National Provider Identifiers on claims when suppliers can't obtain the ordering physician's NPI. That temporary workaround was supposed to be phased out by now, but CMS has postponed edits requiring physicians' NPIs repeatedly.
• Currently, the so-called PECOS edits are scheduled for July implementation for DME suppliers, as well as home health agencies (see related news brief, p. 23).
• Payment errors. Both HHAs and DME suppliers made the list of top six provider types that saw the highest payment error rates in the latest Comprehensive Error Rate Testing report, the OIG notes. "Insufficient documentation, miscoded claims, and medically unnecessary services and supplies accounted for about 98 percent of the improper payments," according to the report.
• Hospice. The OIG examined "questionable billing" from physicians for hospice patients, where the physician billed Part B for services that appeared related to the terminal illness. Often the billing came from independent physicians, but 664 hospices were "associated with Part B questionable claims," the OIG notes. Of the 10 hospices with the highest questionable billing, eight were in Florida, the report points out.
• DME. The OIG examined a number of DME issues in the last six months, including use of the KX modifier and capped rentals.