Review of Costs Claimed by St. Johns Home Health Agency

EXECUTIVE SUMMARY:

This final audit report points out that 75.5 percent of St. Johns' reimbursement claims for providing home health services for the fiscal year ended June 30, 1993 were inappropriate because; (1) 21.5 percent were for home health visits not made, (2) 29 percent were for visits made to individuals who, in their own opinion, or in the opinion of medical experts, were not homebound, (3) 23.5 percent were for visits which physicians denied authorizing, and (4) 1.5 percent were for visits which the beneficiary did not want or were not adequately documented. Of the $45.4 million claimed by St. Johns for FY 1993, we estimate that $25.9 million was for improper claims. While we understand that St. Johns is currently in bankruptcy proceedings, we recommended that the Health Care Financing Administration (HCFA), to the extent possible, recover overpayments as part of those proceedings. The HCFA concurred with our recommendation.