Home Health & Hospice Week

One Massachusetts home health agency audited by the OIG isn’t taking the watchdog agency’s results lying down.

The HHS Office of Inspector General audited 2011 and 2012 claims from Home Health VNA in Lawrence and claimed that the results showed a $314,000 overpayment, according to a new report about the audit. Extrapolating the results, the OIG further said that Home Health VNA owed $15.5 million — $6.3 million within the three-year recovery period and $9.1 million outside that recovery window.

The OIG disallowed claims for homebound status, medical necessity, and insufficient physician documentation, among other reasons.

But Home Health VNAdoesn’t accept those results. Of the 105 claims (out of 497) that the OIG declared non-compliant, Home Health VNA maintains that only seven were correctly identified by the OIG as overpayments and the agency has repaid them, it says in a response letter to the report.

For the other 98 claims, Home Health VNA will appeal the determinations, it says. “We believe that these findings were inappropriately made and that our historic 83 percent success rate on such appeals will result in the reversal of most, if not all, of these claims,” Home Health VNA CEO John Albert says in the letter. Albert also takes the OIG to task for a long list of problems with the audit process from start to finish. “It is difficult for anyone to fully understand the magnitude and impact of this audit process, unless they experience it firsthand,” the letter says. “Home Health VNA has expended uncountable hours working with the OIG in this audit process and in the review of these findings. The fact that we will need to expend further resources over the next three to five years in a claim by claim process just to prove the inaccuracy of these findings is more than disheartening.”

Bottom line: “At the end of this potentially eight year process, both Home Health VNA and the government will spend hundreds of thousands of dollars in administrative processes and not in furtherance of care to patients,” the letter says. “This is a sad commentary on this process.”

See the report, including Home Health VNA’s response letter, at https://oig.hhs.gov/oas/reports/region1/11300518.pdf.