Medicare Home Health Agency Provider Compliance Audit

[The home health agency] did not comply with Medicare billing requirements for 21 of the 100 home health claims that we reviewed. For these claims, [the agency] received net overpayments of $42,229 for services provided during our audit period. Specifically, [they] incorrectly billed Medicare for services provided to beneficiaries who were not homebound and services provided to beneficiaries who did not require skilled services. These errors occurred primarily because [the agency] did not have adequate controls to prevent the incorrect billing of Medicare claims within the selected risk areas. On the basis of our sample results, we estimated that [the agency] received overpayments of at least $478,780 for the audit period.

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