OIG Issues MA Plan Fraud Alert

The Office of Inspector General (OIG), U.S. Department of Health and Human Services, has issued a Special Fraud Alert warning about certain marketing schemes involving the Medicare Advantage (MA) program. These schemes involve questionable payments and referrals between Medicare Advantage plans, health care professionals ( HCPs) , and third-party marketers such as agents and brokers. The Special […]

OIG Audit: Medicare Improperly Paid Acute-Care Hospitals for Outpatient Services Provided to Hospice Enrollees

The findings of a Health and Human Services (HHS) Office of the Inspector General (OIG) audit revealed that Medicare improperly paid acute-care hospitals an estimated $190 million for outpatient services provided to hospice enrollees. The OIG reviewed a random sample of 100 acute-care hospital claims that were paid while a beneficiary was also enrolled in […]

Selected HHAs Complied With Fed Rules for Provider Relief Fund Payments

The selected home health agencies complied with the terms and conditions and federal requirements for expending Provider Relief Funds (PRF) funds, according to a new Office of Inspector General (OIG) of the Department of Health & Human Services (HHS). The $178 billion PRF program provided funds to eligible providers for health care-related expenses or lost […]

OIG Audit Reveals Gaps in OCR’s HIPAA Audit Program

On November 25, 2024, the U.S. Department of Health and Human Services’ (HHS) Office of Inspector General (OIG) published findings from an audit of the Office for Civil Rights’ (OCR) HIPAA Audit Program. The report highlights significant shortcomings in OCR’s implementation and oversight of the program, raising concerns about the protection of electronic protected health […]

Private Duty Home Care in Fraud Enforcers’ Crosshairs

Some owners and managers of private duty home care agencies mistakenly think that fraud and abuse prohibitions apply only to services paid for by the Medicare Program. In fact, fraud and abuse prohibitions apply to providers if they accept any state or federal funds, including, but not limited to, Medicaid, Medicaid waiver, VA, and Tri-Care. Many private […]

Private Duty Home Care in Fraud Enforcers’ Crosshairs

Some owners and managers of private duty home care agencies mistakenly think that fraud and abuse prohibitions apply only to services paid for by the Medicare Program. In fact, fraud and abuse prohibitions apply to providers if they accept any state or federal funds, including, but not limited to, Medicaid, Medicaid waiver, VA, and Tri-Care. Many private […]

CMS Issued Updates to Home Health Claims Processing

The Centers for Medicare & Medicaid Services (CMS) has released Change Request 14543 that reenforces the requirement for home health agencies (HHAs) to report county codes on claims, and makes clarifications  on the Notice of Admission (NOA) timeliness exceptions,  reporting for telehealth visits, and diagnosis code reporting. County codes A recent report from the Office […]

OIG Issues Annual Medicaid Fraud Control Unit Report

On Thursday, March 14th, the Office of Inspector General (OIG) at the Department of Health and Human Services released a report detailing the 2023 outcomes from the State Medicaid Fraud Control Units across the country. The report notably highlighted several areas of interest for home health and personal care providers, further demonstrating the OIG’s emphasis […]

OIG: Home Health Agencies Did Not Use Telehealth Early in the COVID-19 Pandemic

A new report from the U.S Department of Health and Human Services’ Office of Inspector General (OIG) found that home health agencies (HHAs) rarely furnished services via telehealth early in the COVID-19 public health emergency. For the few claims in the OIG sample with services furnished via telehealth, HHAs did not fully comply with Medicare […]

Home health leaders decry OIG report revealing fall reporting noncompliance (mcknightshomecare.com)

HHAs Inaccurately Report Falls with Major Injury

On September 5, 2023, the Office of the Inspector General (OIG) issued a report showing that home health agencies (HHAs)failed to report over half of falls with major injury and hospitalization among their Medicare patients. Fifty-five percent of falls we identified in Medicare claims were not reported in associated Outcome and Assessment Information Set (OASIS) […]

OIG Releases Report on Medicaid Managed Care Prior Authorizations

On July 19, the Office of Inspector General (OIG) at the US Department of Health and Human Services released a report detailing concerns about the prior authorization processes used by Medicaid Managed Care Organizations (MCOs). In the report, OIG found that: On average, the reviewed MCOs denied one out of every eight prior authorization requests […]