OIG: Medicare Contractors Need to Catch More Home Health Care Fraud

Medicare Administrative Contractors (MAC) prevented $275 million of improper payments to home health agencies, but they could do a much better job according to a report from the HHS Office of the Inspector General.

“The four Zone Program Integrity Contractors we reviewed did not identify any HHA vulnerabilities and varied substantially in their efforts to detect and deter fraud,” said the OIG report.

In 2011, the OIG found that Medicare inappropriately paid 5 Home Health Agencies with suspended or revoked billing privileges, and Centers for Medicare & Medicaid Services (CMS) did not act on all revocation recommendations made by MACs.

To prevent further fraud and abuse, the OIG is recommends that CMS establish additional contractor performance standards for high risk providers, develop a system to track revocation recommendations and follow up to prevent inappropriate payments made to agencies.

The Partnership for Quality Care, a trade group representing home health care providers agreed with the recommendations provided.

“Federal data pinpoints where healthcare fraud is occurring. As a result, the federal government can target fraudulent activity, preventing it from occurring in the first place and protecting seniors and taxpayers alike,” said Chairman Billy Tauzin, senior counsel to the Partnership for Quality Home Healthcare.