Medicare Compliance & Reimbursement

Home health agencies bilk Medicare of $1 billion, the OIG says.

The HHS Office of the Inspector General lists no new topics for HHAs in its 2014 Work Plan, but the watchdog agency does continue to list two ongoing areas of investigation: “home health prospective payment system requirements” and “employment of individuals with criminal convictions.”

The PPS topic looks into documentation supporting claims, the OIG Work Plan notes. “Since 2010, nearly $1 billion in improper Medicare payments and fraud has been identified relating to the home health benefit.” With the MACs’ crackdown on face-to-face documentation — particularly the physician narrative — that stat is bound to climb steeply, observers expect.

The criminal background check topic follows on the heels of an OIG report that found 92 percent of nursing homes employed at least one individual with at least one criminal conviction.

Timeline: The OIG plans to issue the PPS report this year and the background check report in 2015, it says in the Work Plan.