Home Health & Hospice Week

OIG auditors seize on physician narrative.

Are you prepared for the HHS Office of Inspector General to present you with a $7.5 million bill if your claims don’t stand up to scrutiny? That’s what is happening to one New York City home health agency.

The OIG audited 555 claims of Brooklynbased Excellent Home Care Services, it says in a new report. The watchdog agency found that 156 of the claims from 2011 and 2012 were not compliant with Medicare rules. Problems included homebound, medical necessity and physician documentation requirements, the OIG says.

The 156 claims resulted in an overpayment of nearly half a million dollars, the OIG says. That indicates the agency received $7.5 million in overpayments for the entire audit period, the OIG estimates.

The problems the OIG auditors found were often out of the agency’s hands, its attorney indicates in a response letter to the report. “Often, the auditors seized upon comments in the face-to-face narrative that were inconsistent,” says Duane Morris  attorney Jerome Levy in the letter.

See the report at https://oig.hhs.gov/oas/reports/region2/21401005.pdf.