An audit conducted by the Department of Health and Human Services’ Office of Inspector General found that The Palace at Home, a Medicare home health agency in Miami, did not comply with Medicare billing requirements for 20 of the random sample of 100 home health claims audited, resulting in overpayments of $30,387 for this sample group, according to the OIG. Based on these sample results, the OIG estimated that The Palace received overpayments of at least $731,304 for the audit period.
The audit covered approximately $14.1 million in Medicare payments to The Palace for 3,851 claims in 2015 and 2016. The OIG said that billing errors in the sampled claims included provision of services to beneficiaries who were not homebound or did not require skilled services, and processing of claims that were assigned incorrect Health Insurance Prospective Payment System codes.
“These errors occurred primarily because The Palace did not have adequate controls to prevent the incorrect billing of Medicare claims,” the OIG said.
The federal agency recommends that The Palace identify, report and return any overpayments and revise its procedures to ensure full compliance with requirements for billing home health services.
The Palace plans to appeal the findings.
A consultant hired by the home health agency submitted a report to the OIG, which was reviewed by the federal agency’s medical review contractor along with The Palace’s comments about the draft report.
“Based on the results of this review, we removed 12 of the 32 claims originally found to be in error in our draft report and adjusted the findings for an additional 5 claims,” the OIG wrote. “With these actions taken, we maintain that our remaining findings and recommendations are valid, although we acknowledge The Palace’s rights to appeal the findings.”