Medicare Compliance Review of Excellent Home Care Services, LLC

Excellent Home Care Services, LLC (the Agency) (located in Brooklyn, New York), did not comply with Medicare billing requirements for 156 of the 555 home health claims we reviewed. As a result, the Agency received net overpayments of $498,000 for calendar years 2011 and 2012. Specifically, the Agency incorrectly billed Medicare for some beneficiaries who were not homebound, some beneficiaries who did not require skilled services, and some services for which the documentation from the certifying physician was missing or insufficient to support the services. These errors occurred primarily because the Agency did not have adequate controls to prevent the incorrect billing of Medicare claims within selected risk areas.

On the basis of our sample results, we estimated that the Agency received net overpayments of at least $7.5 million for the audit period. This overpayment amount includes claims with payment dates outside of the 3-year recovery period. Of the total estimated overpayments, at least $6.3 million have payment dates that are within the 3-year recovery period and at least $1.1 million was outside the 3-year recovery period. The Agency, through its attorneys, did not indicate concurrence or nonoccurrence with our recommendations.