Home Health & Hospice Week

Feds assess $685,000 overpayment for denied therapy visits.

The HHS Office of Inspector General has handed down the fourth in its series of audits of home health agency episodes that include 10 to 12 therapy visits, and it contains more bad news for the industry.

The Centers for Medicare & Medicaid Services will use the audit as a "club over home health," warns consultant Tom Boyd with Rohnert Park, CA-based Boyd & Nicholas.

The OIG via regional home health intermediary Cahaba GBA audited 100 fiscal year 2003 claims from Springfield, MO HHA Oxford Healthcare. The claims barely exceeded the therapy threshold with 10 to 12 visits, which netted the episodes an extra $1,800 a piece, the OIG's audit report notes.

Of the 100 sampled claims, 41 included medically unnecessary therapy services, four lacked proper authorization for the therapy services, and 11 claims had beneficiary assessment errors, the OIG says. When applied to the universe of Oxford's 851 therapy claims with 10 to 12 visits for that year, the agency owes more than $685,000 back to the Medicare program, the report maintains.

Oxford "respectfully disagrees with many of the determinations made by OIG auditors ... and continues to stand behind the claims it has submitted," the agency says in a response letter included with the report.

Note: For more information on the audit, see next week's issue of Eli's Home Care Week.