Home Health & Hospice Week

Statistical sampling and extrapolation have led to a $38.8 million overpayment request for publicly traded chain Amedisys Inc.

On Aug. 17, Amedisys “received a Request for Repayment from Palmetto GBA … regarding Infinity Home Care of Lakeland, LLC, which includes the Winterhaven, Tampa, and Bradenton, Florida care centers,” the Baton Rouge-based company says in a Securities and Exchange Commission 8-K filing. “The Palmetto letter is based on a statistical extrapolation performed by Zone 7 Program Integrity Contractor SafeGuard Services … which alleged an overpayment of $34.0 million on a universe of 72 Medicare claims totaling $0.2 million in actual claims payments using a 100 percent error rate.”

Plus: On Aug. 25, Amedisys “received a Request for Repayment from Palmetto regarding Infinity Home Care of Pinellas” in Clearwater, the filing continues. “The Palmetto letter is based on a statistical extrapolation also performed by the ZPIC contractor, which alleges an overpayment of $4.8 million on a universe of 70 Medicare claims totalling $0.2 million in actual claims payments using a 100 percent error rate.”

Amedisys is disputing the claims, says it has repaid a portion already based on a self-audit, and “will aggressively challenge the statistical method used to determine the extrapolated overpayment,” it says. The company acquired the locations in December 2015. The prior owners may be responsible for up to $12.6 million of the overpayment, according to the filing. Amedisys estimates its loss will range from $6.5 million up to the full overpayment amount.

Also, the chain will close four Florida home health locations, consolidate another three Florida home health centers with centers servicing the same markets and implement a restructure plan in the company’s home health segment, it says. “These actions are expected to be completed during the fourth quarter of 2017.”