Department of Health and Human Services

Office of Inspector General -- AUDIT

"Review of Medicare Payments to Partners Home Care for Home Health Services Preceded by a Hospital Discharge," (A-01-07-00503)

November 27, 2007


PDF File Complete Text of Report is available in PDF format (1.16 mb). Copies can also be obtained by contacting the Office of Public Affairs at 202-619-1343.


EXECUTIVE SUMMARY:

Our objective was to determine whether Partners Home Care (the agency) complied with Medicare requirements in billing for fiscal year 2004 and 2005 services for beneficiaries who had been discharged from an acute care hospital in the preceding 14 days.  The agency improperly coded 231 of these claims as if the beneficiary had not had an acute care stay in the preceding 14 days.  The Centers for Medicare & Medicaid Services's prepayment edit corrected 155 of the 231 claims.  During our review, the agency corrected 28 of these claims totaling $13,451.  The 48 remaining unadjusted claims represented overpayments of $16,443. 

We recommended that the agency ensure that its adjustment for the $13,451 in overpayments for the 28 claims was processed by the regional home health intermediary, return the $16,443 in overpayments associated with the remaining 48 unadjusted claims to the regional home health intermediary, and further educate its staff regarding the importance of identifying all facilities that had discharged the beneficiary within 14 days of the home health episode and determining which of these facilities were acute care (including long term care) hospitals.  The agency generally agreed with our findings but did not accept responsibility for the overpayments.