Home Health & Hospice Week

The HHS Office of Inspector General is trumpeting its success with its HEAT initiative in the home health arena.

In its HHS-OIG FY 2014 Performance Budget Submission, the watchdog agency notes that in 2009 Medicare paid more than $977 million to home health agencies in the Miami area. More than half of these home health payments — $558 million — were for outliers. In 2011, payments dropped more than 36 percent to $618 million and outliers made up just 5 percent of that. That totaled a 90 percent drop in outlier payments from 2009 to 2011, the OIG notes.

"Strike Force teams identify individuals and groups actively involved in Medicare fraud and stop the fraud activity early," the OIG maintains. "Analysis teams use near-real-time data to examine Medicare claims for patterns of suspected fraud. The analysis includes studies of suspected fraud trends and ratios of allowed services as compared with national averages, as well as other assessments that enable OIG to identify, and adapt enforcement efforts to, emerging fraud trends as they evolve."

For example: "The use of more sophisticated data analytic approaches has enabled OIG enforcement efforts to adapt to shifts in criminal health care fraud patterns from durable medical equipment supplier and infusion clinic schemes to home health care and other types of fraud schemes," the OIG says.

The submission is at http://oig.hhs.gov/reports-and-publications/archives/budget/files/FY2014_HHSOIG_Congressional_Justification.pdf