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Department of Health and Human Services

Office of Inspector General -- AUDIT

"Review of Medicare Home Health Services in Florida," (A-04-99-01195)

March 14, 2001


Complete Text of Report is available in PDF format (1.7 mb). Copies can also be obtained by contacting the Office of Public Affairs at 202-619-1343.

EXECUTIVE SUMMARY:

This final report points out that, based on our statistical sample, at least $38.3 million of $649.8 million in Florida home health agency (HHA) claims for the 9-month period ending September 30, 1998 were unallowable or highly questionable. The majority of the unallowable claims were, in our opinion, the result of inadequate physician involvement. We found physicians did not always review or actively participate in developing the plans of care they signed. Among other things, we recommended that the Health Care Financing Administration (HCFA) revise Medicare regulations to require certifying physicians to examine patients before ordering home health care services and see the patient at least once every 60 days. The HCFA did not concur with this recommendation, believing the new prospective payment system for home health services will significantly reduce the incentive to provide unnecessary services. However, the OIG has identified the lack of physician involvement as a long-standing problem significantly contributing to improper claims and payments. Consequently, we continue to emphasize the need for corrective action in this regard.