Review of Requests for Anticipated Payment under the Medicare Home Health Prospective Payment System at Palmetto Government Benefit Administrators, LLC between October 1, 2000 and April 26, 2001

EXECUTIVE SUMMARY:

This report provides the results of our review of requests for anticipated payments (RAPs) under the Medicare home health (HH) prospective payment system (PPS) at Palmetto Government Benefits Administrators, LLC (Palmetto).  Due to system problems with the Fiscal Intermediary Standard System (FISS), Palmetto improperly paid about $15 million to home health agencies (HHAs) for non-covered and denied charges.   We recommended that Palmetto (i) take action to recover improperly paid RAPs and (ii) implement procedures to ensure that future overpayments are identified and recovered timely.  Palmetto stated it had manually cancelled the improperly paid RAPs and recouped 95 percent of the amount due.  We did not perform any tests to verify that Palmetto cancelled these improperly paid RAPs and correctly calculated the amount systematically recouped. We plan to follow-up on Palmetto’s recovery actions in the future.