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Department of Health and Human Services

Office of Inspector General -- AUDIT

"Review of Costs Claimed by Pro-Med Home Health, Inc.," (A-04-95-01106)

March 22, 1996


Complete Text of Report is available in PDF format (830 kb). Copies can also be obtained by contacting the Office of Public Affairs at 202-619-1343.

EXECUTIVE SUMMARY:

This final audit report points out that 40 percent ($1.2 million) of home health claims submitted by Pro-Med Home Health, Inc. during the fiscal year ended December 31, 1993 did not meet Medicare guidelines in that: (1) 25 percent were for home health visits made to individuals who were not homebound; (2) 8 percent were for visits which in the opinion of medical experts were not reasonable or necessary; (3) 5 percent were for visits not made; and (4) 2 percent were for visits which physicians denied authorizing. In addition to recovering overpayments, we recommended that the Health Care Financing Administration (HCFA) require the fiscal intermediary (FI) to instruct Pro-Med on its responsibilities to monitor its subcontractors for compliance with Medicare guidelines, and monitor the FI and Pro-Med to ensure that corrective actions are effectively implemented. The HCFA agreed with our recommendations