Review of Home Health Services Provided by the Lifeline Health Group, Inc.

EXECUTIVE SUMMARY:

The objective of this review was to determine whether Medicare payments to Lifeline for home health services met Medicare eligibility and reimbursement requirements.  Based on a statistical sample, we estimate that Lifeline was paid about $1.2 million for home health services that did not meet Medicare eligibility and reimbursement requirements.  Lifeline billed for:  beneficiaries who were either not homebound or whose homebound status was not adequately documented; beneficiaries who had no need for qualifying skilled services; services that were not reasonable or necessary for the beneficiary's condition; services not properly authorized by a physician; and services not supported by documentation.  We recommended that Lifeline:  (1) examine the errors identified and develop additional admission controls, financial controls, and training to ensure that these types of errors do not occur in the future, and (2) work with the fiscal intermediary to reimburse the Medicare program the estimated overpayment of $1.2 million.