OIG: Home health claims add up to $432M improper Medicare payments

Home health agencies submitted 22 percent of claims in error for unnecessary medical services or for incorrect coding in 2008. That adds up to $432 million in improper Medicare payments, according to an Office of Inspector General (OIG) report released Tuesday. Of those, home health agencies upcoded about 10 percent ($278 million) of claims. Further, Medicare spending on home health increased 84 percent from $8.5 billion in 2000 to $15.7 billion in 2007. The rise in home health spending is suspect. The OIG suggested the increased spending is due to improper payments from fraud and abuse. "Given the general concern about risks to the Medicare program in the home health area, further investigations beyond the medical record are needed to determine whether beneficiaries are eligible, services are furnished, and Medicare requirements for payment are met. OIG will continue to monitor Medicare home health claims to determine whether the services are appropriate and merit payment," the agency said.

And last month, the OIG pointed out that home health has "limited" oversight. Home health agencies did not submit required Outcome and Assessment Information Set (OASIS) data for 6 percent of the claims in 2009, which represented more than $1 billion in Medicare payments, according to another OIG report. Announcement