Printer Friendly, PDF & Email

OIG Audit Report: CMS could use CERT data to identify high-risk home health agencies

In September 2019, the US Department of Health and Human Services Office of Inspector General released the result of an audit report, “The Centers for Medicare & Medicaid Services Could Use Comprehensive Error Rate Testing Data To Identify High-Risk Home Health Agencies”.

The OIG noted, as the report title suggests, CMS could use CERT data to identify high-risk home health agencies (HHAs) as a part of a multifaceted approach that includes targeted probe-and-educate reviews as well as aspects of its Fraud Prevention System to further reduce improper payments and the error rate for claims paid to HHAs. “Using nationally reported CERT program data for fiscal years (FYs) 2014 through 2017, [OIG] identified 87 high-risk HHAs, which in the CERT sample had an improper payment rate of about 78 percent and approximately $1 million in actual improper payments. Using Medicare program data during this same period, we determined that Medicare paid these 87 HHAs more than $4 billion for services.”

This document is only available to members. Please log in or become a member