OIG Places 562 Home Health Agencies and 4,500 Physicians on Red Flag List - 7-12-2016

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