Planned Work: Comparing HHA Survey Documents to Medicare Claims Data

Through the survey and certification process, CMS and State agencies may identify potentially unqualified or fraudulent providers because of their direct contact with these providers. Home Health Agencies (HHAs) supply patient information (i.e., rosters and schedules) to State agencies during the recertification survey process, but State agencies do not have access to Medicare claims data to verify this information. Therefore, fraudulent HHAs might intentionally omit certain patients from information supplied to State agencies to avoid scrutiny. Previous OIG work has shown that the home health program is prone to fraud, waste, and abuse. We will determine whether HHAs are accurately providing patient information to State agencies for recertification surveys.

Read OIG Work Plan Description