OIG’s list of problem providers outlines faults

Some doubt Feds’ claim that it isn’t a hit list

A list of "problem providers" in home health includes a set of the qualifications that can make your home health operation a target for the federal anti-fraud campaign. If you’re not already on the list, the report may help you avoid that dubious honor.

Compiled by the U.S. Office of the Inspector General (OIG) for the purposes of a study in July 1997 titled Home Health Problem Providers and Their Impact on Medicare (OEI-09-96-00110), the list contains the names of 698 home care agencies based in the original Operation Restore Trust states of California, Texas, Florida, New York, and Illinois. The list quickly became known among providers as "the 700 Club."

OIG deputy inspector general George Grob says the list was never meant to be released to the public but, as a government document, it was released once a consultant filed a Freedom of Information Act request. He assures home health providers that it is not a black list or hit list. Instead, he explains, it was part of a study meant to identify "vulnerabilities" in Medicare’s home health program.

"I want to allay the fears of the industry," he says. "The list was never meant to be released or meant as a list to go after industry leaders. We do not maintain such a list."

Many home health providers say that is not reassuring. Ann Howard, executive director of the American Federation of Home Health Agencies, says the OIG list of "problem providers" suggests that even a legitimate disagreement between a provider and a fiscal intermediary over Medicare reimbursement is reason enough to be suspected of fraud.

Even if the OIG never meant the list to be publicized, it still sheds light on how the OIG views home health agencies when considering fraud, she says.

The OIG report describes a "problem" agency as "one that has abused or defrauded Medicare or misappropriated Medicare funds through the cost report or claims process."

Defining the problem agency

The report further states that a problem agency is one that has been identified by the Health Care Financing Administration in Baltimore, a fiscal intermediary, the state cert- ification or licensing agency, or the OIG as meeting at least one of the conditions outlined below:

• has incurred significant uncollected overpayments;

• routinely submits cost reports with significant inappropriate and unallowable costs;

• files a cost report that is determined to be unauditable;

• routinely does not file cost reports within a reasonable time;

• has submitted multiple claims for services that are not medically necessary;

• has submitted multiple claims for services that were not rendered;

• continues to submit problem claims despite educational contacts;

• has significant certification deficiencies;

• has been referred to the fiscal intermediary’s program integrity unit;

• has been referred to the OIG by the fiscal intermediary.