Review of Payments Made by United Government Services for Home Health Services Preceded by a Hospital Discharge

EXECUTIVE SUMMARY:

The Centers for Medicare and Medicaid Services (CMS) provides for a lower payment for home health services rendered to beneficiaries discharged from an acute care hospital within 14 days immediately preceding admission to home health care.  Based on a statistically valid sample, we estimated that United Government Services (United) overpaid home health agencies (HHAs) approximately $5.3 million for fiscal year 2001 claims that did not meet this 14-day requirement.  These overpayments occurred because HHAs did not provide the necessary or correct information to United, and United had not established adequate postpayment controls to detect HHA claims that were billed incorrectly.  In addition to financial adjustments, we recommended that United provide education to HHAs to ensure that beneficiary discharge data are completed accurately on patient assessment instruments.