Submitting OIG:
Report Description:
Under the home health prospective payment system (PPS), the Centers for Medicare & Medicaid Services pays home health agencies (HHAs) a standardized payment for each 60-day episode of care that a beneficiary receives. The PPS payment covers intermittent skilled nursing and home health aide visits, therapy (physical, occupational, and speech-language pathology), medical social services, and medical supplies.Our prior audits of home health services identified significant overpayments to HHAs. These overpayments were largely the result of HHAs improperly billing for services to beneficiaries who were not confined to the home (homebound) or were not in need of skilled services.Our objective was to determine whether Visiting Nurse Association of Central Jersey Home Care and Hospice, Inc., (VNA of Central Jersey) complied with Medicare requirements for billing home health services on selected types of claims.
Date Issued:
Thursday, October 29, 2020
Agency Reviewed / Investigated:
Submitting OIG-Specific Report Number:
A-02-17-01025
Component, if applicable:
Centers for Medicare & Medicaid Services
Location(s):
NJ
United StatesType of Report:
Audit
Questioned Costs:
$2,015,925
Funds for Better Use:
$0
Number of Recommendations:
5