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Comparing HHA Survey Documents to Medicare Claims Data

Through the survey and certification process, the Centers for Medicare & Medicaid Services 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 (e.g., rosters/censuses, admission/discharge lists to surveyors during the recertification survey process. Surveyors rely on this information to select patients for review, but cannot verify that the information is complete. Therefore, fraudulent HHAs—or HHAs with serious quality problems— might intentionally omit certain patients from information supplied to surveyors to avoid scrutiny. Previous OIG work has shown that the home health program is prone to fraud, waste, and abuse. We will explore this potential vulnerability, and look for evidence of patients omitted from HHA-supplied patient information from select recertification surveys using Medicare claims data.

Announced or Revised Agency Title Component Report Number(s) Expected Issue Date (FY)
Nov-16 Centers for Medicare & Medicaid Services Comparing HHA Survey Documents to Medicare Claims Data Office of Evaluation and Inspections OEI-05-16-00510 2018

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