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The U.S. Department of Health and Human Services Office of Inspector General released a report that showed that the New York State Health Department should refund $69.1 million in Medicaid reimbursement to the federal government for improper claims submitted by New York City-certified home health agencies (CHHA). The report also recommended that the state issue guidance to CHHAs in New York City on federal and state requirements for physicians' orders and care plans.
A random sample of 100 claims from the January 2007-December 2009 audit period showed that a total of 83 claims met federal and state requirements, but 17 claims did not meet the requirements because they were not based on a written care plan reviewed by a physician every 60 days, as required, and in one of them, the provider could not document that the service was provided in 8 of the 20 hours billed.
The 100 claims reviewed from New York City included 76 home health aide services, 22 nursing services, and 2 physical therapy services. The random sample was drawn from some 8 million claims.
The auditors plan to issue a separate report on the state agency's claims for home health services submitted by CHHAs outside New York City.