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Home health agencies (HHA) that billed unusually high amounts, according to at least 1 of the 6 measures of questionable billing, have been identified in Inappropriate and Questionable Billing By Medicare Home Health Agencies, a new report from the Office of Inspector General (OIG).
Although these 6 measures indicate potential fraud, there may be legitimate reasons for an HHA to exceed the threshold for unusually high billing on any of the 6 measures.
OIG also determined the geographic locations of HHAs that had questionable billing. The OIG found that in 2010, Medicare inappropriately paid $5 million for home health claims with three specific errors:
The OIG recommends that CMS:
CMS concurred with all 5 recommendations; however, it disagreed with our estimate of the inappropriate payments for home health claims overlapping with claims for inpatient hospital stays and skilled nursing facility stays.