In June the
Office of Inspector General of the Department of Health and Human Services
issued a nationwide analysis of common characteristics in OIG home health fraud
cases. 470 home health agencies had an
unusually high percentage of home health episodes for which the beneficiary had
no recent visits with the supervising physician. 483 home health agencies had an unusually
high percentage of home health episodes with primary diagnosis of diabetes or
hypertension. 770 home health agencies
were outliers on the percentage of beneficiaries who received home health care
from 3 or home health agencies over the course of 2 years. 778 home health agencies had an unusually
high percentage of beneficiaries with multiple home health readmissions in a
short period of time. Listed below two
tables of home health information:
|
Home Health Agencies Outlier
Characteristics
|
|
|
Description
|
#
of Agencies
|
|
Outliers on 2 characteristics
|
469
|
|
Outliers on 3 characteristics
|
84
|
|
Outliers on 4 characteristics
|
9
|
|
Home
Health National Medians and Outlier Thresholds
|
||||
|
Characteristics
|
National
Median |
Threshold
For
Outliers
|
Number
of
Outliers
|
Outliers as a
Percentage
of Total
|
|
No recent visit with the supervision physician
|
22.6%
|
62.5%
|
470
|
3.9%
|
|
Diabetes of hypertension diagnosis
|
10.1%
|
45.1%
|
483
|
4.0%
|
|
Beneficiaries with claims from multiple HHAs
|
6.3%
|
25.9%
|
770
|
6.5%
|
|
Readmission
shortly after discharge
|
5.6%
|
19.3%
|
778
|
6.5%
|
Where does your agency stand with these
Characteristics?
For more
information, please go to:
https://oig.hhs.gov/oei/reports/oei-05-16-00031.pdf
