The U.S. Department of Health and Human Services Office of Inspector General recently announced 14 new inquiries into potentially fraudulent Medicare/Medicaid billing by healthcare providers including home health agencies and hospitals. The OIG said it will update its investigative work plan monthly rather than once or twice per year.
OIG said that the “improper payment error rate” for home health billing was more than 40% and approximately $7.7 billion last year. OIG will look at common characteristics of “at risk” home health providers in an effort to target audits better. OIG is also looking at whether hospitals are improperly seeking extra reimbursement under Medicare Part B for outpatient services performed around the time of an inpatient admission reimbursed by Medicare Part A. In its recent update, OIG also said it would review ambulance companies which provide services to nursing home residents. OIG plans to review whether ambulances appropriately bill nursing homes for services provided during nursing home visits and Medicare when the visits are covered by Medicare Part A. OIG also plans to review adult day centers and telemedicine to ensure compliance with regulations.