OIG says $2.6 billion in paid claims unallowable
OIG says $2.6 billion in paid claims unallowable
Latest Medicare probe focuses on four states
A report from the Office of Inspector General’s latest investigation of alleged Medicare fraud in the home health industry simmers in ominous silence at Health Care Financing Administration headquarters, but its eventual release could trigger an explosion.
Although the report has not been officially published, its findings have been referred to obliquely in recent speeches by Health and Human Services Director Donna Shalala, who has indicated OIG’s probe "will show a 25% to 40% error rate in favor of HHAs," an OIG official says.
The result of a 15-month-long audit of Medicare home health claims in four states, the report will show that $2.6 billion in "inappropriate claims" was paid by intermediaries to home care agencies.
It is uncertain when the official version of the audit, conducted under the auspices of the Oper ation Restore Trust (ORT) initiative, will be released by HCFA and the OIG. Sources say the report was sent to HCFA in March and had been expected back before now.
"It usually takes about four to six weeks turnaround for one of these reports," an OIG official says, "but it could be two weeks, two months, or six months. We don’t know."
Covering the 15-month period prior to March 1996, the study scrutinized claims in California, Illinois, New York, and Texas, states targeted in the ORT initiative.
"Out of the four-state universe of $6.7 billion in Medicare payments, $2.6 billion of it was found to be unallowable," the OIG says.
A total of 250 claims in the four states were reviewed during the audit. The OIG says it separated the claims into five 50-claim categories to reach its conclusion.
The findings include such violations as "unnecessary services, individuals not being homebound, no signatures of plans of care, care plans dated and signed after service had begun, or no doctor’s order," the OIG official discloses.
"They’re some of the same things we have found in other reviews we’ve done in the home health arena."
Subscribe Now for Access
You have reached your article limit for the month. We hope you found our articles both enjoyable and insightful. For information on new subscriptions, product trials, alternative billing arrangements or group and site discounts please call 800-688-2421. We look forward to having you as a long-term member of the Relias Media community.