OIG List 6 Home Health Questionable Billing Practices

Number 1 - HHAs that have a high average of outlier payment amounts per beneficiary. They stated their threshold was above $403 per beneficiary.

Number 2 - HHAs that billed unusually high number of visits per beneficiary. They stated their threshold was above 90 visits per beneficiary.

Number 3 - HHAs that had an unusually high percentage of beneficiaries for who other HHAs billed Medicare. The stated their threshold was 61 percent.

Number 4 - HHAs that had an unusually high numbers of late episodes per beneficiary. They stated the threshold was more than 2 late episodes per beneficiary.

Number 5 - HHAs that billed for unusually high numbers of therapy visits per beneficiary. They stated the threshold was above 23 therapy visits per beneficiary.

Number 6 - HHAs how had unusually high payments per beneficiary. They stated the threshold was $11,652 in payments per beneficiary.

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