HRS' home health care received an overpayment of at least $100,696, according to a recent audit report from the Office of Inspectors (OIG).
The results are from a series of in-home audits that examined how institutions adhere to Medicare requirements. HRS Home Health is one of the audited institutions.
Based in Lombard, Illinois, HRS Home Health is a for-profit home healthcare facility. The company's Medicare management contractor, Palmetto GBA, paid $35 million for HRS' home health care on 18,422 people's bills for services offered to Medicare enrolled in 2020 and 2021.
The Centers for Medicare & Medicaid Services (CMS) found in 2023 an inappropriate payment error rate of 7.7% on bills, reaching around $1.2 billion. This was one of the reasons why OIG decided to conduct an audit.
Overall, OIG reviewed a random sample of 100 home health claims, with a total of $227,528 payments.
“We evaluated these claims regarding compliance with selected claims requirements and submitted these claims to an independent medical review to determine whether the service meets coverage, medical needs and coding requirements,” OIG wrote in its report.
In 2023, home healthcare institutions received approximately $16 billion in Medicare payments for care services provided to 2.8 million people. That year, around 10,000 home healthcare institutions participated in Medicare.
OIG found that 80 of the 100 home health care workers claim that the reviewed organizations comply with Medicare claim requirements. The 20 in-home health claims that were incorrectly charged either did not meet the claims and coding requirements, did not meet the planning plans for care, or did not meet the requirements for skilled needs.
OIG has created a set of recommendations for HRS's at-home hygiene. The organization recommended that OIG refund $100,696 for overpayments to the Medicare program.
OIG also suggested that HRS home health care must conduct one or more internal audits or investigations to identify similar overpayments and return funds to the Medicare program.
OIG also called for HRS home health care to enhance reviews of medical records documents, confirming that it complies with Medicare claims requirements.
HRS' home health care has agreed to pay back seven claims, but the company pushed back the $100,696 full.
“HRS' home health care did not agree with the recommendation to repay an estimated overpayment of $100,696,” Oig wrote. “HRS' home healthcare is noted that “1% payment error rates obtained from OIG reviews cannot be reasonably characterized as “sustained or high-level payment errors” necessary to justify extrapolation.” It's acceptable. '”
