Daniel Levinson, the inspector general of the U.S. Department of Health and Human Services (HHS), says results from a new study suggest problems with Medicare home health agency billing realy may be common.
An analysis of Medicare billing data suggest that questionable home health agency billing may be especially common in 4 states.
Levinson says the Centers for Medicare & Medicare Services (CMS), the arm of the HHS that oversees Medicare, should consider imposing a temporary moratorium on new home health agency enrollments in Florida and Texas.
In those states and others, CMS should increase monitoring of home health services, be tougher about paying what appear to be unusual bills, and take steps to prevent Medicare from paying bills that appear to be affected by three specific types of errors, Levinson says in a report summarizing the findings of investigators at the HHS Office of Inspector General (OIG) on inappropriate and questionable Medicare home health agency billing.
Medicare does not pay for long-term care (LTC) in nursing homes, but it does pay for some short-term recovery care in nursing homes, and it does pay for home health care. It paid $19.5 billion to 11,203 home health agencies in 2010. The agencies served 3.4 million people, or about 1% of the U.S. population.
Home health services billing is vulnerable to fraud, waste and abuse, Levinson says.
In the report, he cites a recent case involving a Texas physician who helped home health agencies bill Medicare for $350 million for services that were not medically necessary or were not provided.
Earlier HHS OIG work comparing claim billing codes with medical records indicated that 22% of Medicare home health agency claims are in error because the services provided were not medically necessary or the claims were coded in accurately, and those erroneous claims led to $432 million in improper payments, Levinson says.
That review compared only billing codes to records and did not determine whether the records themselves were accurate, Levinson says.