The Centers for Medicare and Medicaid Services (CMS) implemented new billing requirements for home care agencies. While these requirements are said to be hampering the services some agencies and organizations offer clients, there is evidence of why these new rule changes were implemented.
During an audit, a Michigan based home health care provider that also offered in-home care support to clients in Indiana and Illinois was found to have received $10.5 million in overpayments through Medicare for the years 2014 and 2015. Part of the reason for this overpayment involved noncompliance with Medicare billing requirements, according to the audit. However, the company CEO disputed the overbilling charge.
As reported by nwi.com in its blog, Home health provider received $10.5 million in Medicare overpayments, audit alleges, written by Dan Carden:
“According to the report, 38 of the 100 home health claims sampled as part of the audit did not comply with Medicare billing requirements. Extrapolating that result to Great Lakes’ 22,511 total claims worth $69,745,515 during the two-year period equates to $10,486,922 in overpayments, the audit said.
The inspector general is requesting that money be refunded to the Medicare program. Great Lakes CEO Adam Nielsen vigorously disputed the purported overbilling in a written response to a draft version of the audit.
Nielsen said the inspector general’s medical reviewer did not apply Medicare’s homebound requirements correctly, and confused the distinctions between services provided by physical and occupational therapists and those provided by home caregivers.”
Adam Nielsen went on to say, “We are responsible stewards of the Medicare program under which we operate, and we have always fostered a culture of compliance. It is a central pillar to our company.”
The inspector general admitted that some of the findings were adjusted based on the company’s response to the audit, but that the ultimate findings and recommendations of the audit remained valid.
Overall, it is reported that improper payments made as a result of inadequate billing requirements accounted for a total of 18 percent of $41 billion in improper payments through the system.
Currently, the inspector general is relying on several systems, including data mining and analysis, computer matching, and other techniques to detect noncompliance among other home health care companies.
It is unclear what recourse Great Lakes has with the audit findings, but it appeared the CEO plans to fight the charges. It is also unclear what level of impact repayment of the overbilled amount could have on the services the company provides to its current clients.