Home Health & Hospice Week

Gentiva Health Services Inc.' challenge to an extrapolation case has been shot down in federal court.

Background: A Medicare contractor in 2007 reviewed 30 claims from Gentiva agency Her-itage Home Health and found a "sustained or high level of payment error" of 86 percent, according to an April 6 opinion from the U.S. District Court for the District of Columbia. The contractor extrapolated that error rate to the universe of 1,951 claims and sought to recoup $4.2 million from Gentiva.

Most of the claims determinations were overturned on appeal and the overpayment amount was reduced to about $850,000, the opinion ex-plains. But the Department of Health and Human Services upheld the use of extrapolation in the case.

"In this suit Gentiva claims that the Secretary's decision upholding the contractor's use of extrapolation to calculate its overpayment amount was 'arbitrary, capricious, an abuse of discretion, or otherwise not in accordance with law'" the opinion notes. Gentiva argues that HHS, not a Medicare contractor, must make the "sustained or high level of payment error" determination before a contractor can use extrapolation. And Gentiva challenges the merits of the contractor's determination that a "sustained or high level of payment error" was present, the opinion says.

Denied: "The Court finds that the Secre-tary's determination that a contractor may make the 'sustained or high level of payment error' determination was neither arbitrary and capricious nor contrary to law," concludes the opinion in GENTIVA HEALTHCARE CORP. v. SEBELIUS.