Review of Mutual of Omaha's Settlement Procedures for Provider-Based Home Health Agencies

This report provides the results of our review of Mutual of Omaha's (Mutual's) settlement procedures for provider-based home health agencies (HHAs).   The objective of our review was to determine whether Mutual had adequate controls to settle HHA cost reports.   We found that Mutual did not always settle HHA cost reports using reliable Provider Statistical and Reimbursement (PS&R) data.  Consequently, Mutual overpaid two HHA providers a total of $179,018 because Mutual used incorrect PS&R data. Additionally, Mutual found that periodic interim payments (PIP) were incorrectly determined at final settlement.  Mutual revised PIP for the two providers, which increased the total overpayment to $316,949.