FutureFocus March 21, 2018 Trending Industry News

Lisa Remington

In this week’s FutureFocus, Attorney Elizabeth Hogue provides additional insights about hospital discharge planners and their recommendations of post-acute providers. Elizabeth ties into the discussion Conditions of Participations (CoPs) and standards of care. In our Washington Report, we discuss an OIG report and the vulnerability to fraud in unverified home health agency patient lists. Don't miss the CMS Special Open Door Forum on the IMPACT Act and improving care coordination. We provide details and additional reading for that call.

Lisa Remington, President, Remington Health Strategy Group

Some of the patient lists home health agencies supplied to surveyors were missing names of Medicare beneficiaries, according to a recent study by the HHS Office of Inspector General (OIG). “Although we do not know the reasons for these omissions,” the OIG noted, this “creates a vulnerability because HHAs could conceal fraudulent activity or health and safety violations by omitting patients from those lists.”

The agency added that home health surveyors rely on lists supplied by HHAs to select patients for review.

OIG’s methodology: Conducted interviews on the survey process and did a retrospective comparison of HHA-supplied patient lists and Medicare claims data. In March 2017, OIG interviewed five State survey agencies (California, Illinois, Florida, Michigan, and Texas), the four CMS regional offices associated with those five States, the three CMS-approved accrediting organizations, and the CMS central office.

“Home health has long been recognized by OIG and CMS as a program area vulnerable to fraud, waste, and abuse…. While home health fraud schemes vary in nature, OIG investigations commonly find that HHAs are billing for services that are not medically necessary and/or not provided.”

Nine of the 28 HHA-supplied rosters OIG reviewed were incomplete. The most striking example: “One HHA was missing over 150—or nearly 90 percent—of its active beneficiaries.”

According to CMS’ State Operations Manual, surveyors should use HHA-supplied patient lists to help choose a sample of patients. Surveyors generally ask HHAs to supply patient lists, OIG noted, including the following:

  • a roster, which is a list of all active patients at the time of the survey; and,
  • an admissions list, which is a list of patient admissions prior to the survey.


OIG Recommendations “to mitigate this vulnerability”

“We also found that surveyors cannot comprehensively verify that HHA-supplied patient lists are complete at the time they conduct their surveys,” OIG stated. “However, existing data sources may be useful tools both for surveyors” and CMS. 

OIG “encourages CMS to explore actions to mitigate this vulnerability, including using existing data to provide better information for surveyors and conducting retrospective reviews.” 

“Home health has long been recognized by OIG and CMS as a program area vulnerable to fraud, waste, and abuse…. While home health fraud schemes vary in nature, OIG investigations commonly find that HHAs are billing for services that are not medically necessary and/or not provided.”

However, in regard to this study, OIG noted its limitations: “Our results are based on a selection of HHAs that is not representative, and therefore cannot be generalized to the overall population of HHAs. Additionally, our results cannot speak to whether beneficiaries were missing from rosters as a result of intentional, rather than accidental, omission.”

Title of the report: “Reliance on Unverified Patient Lists Creates a Vulnerability in Home Health Surveys.”

By: Ronald M. Schwartz, Writer, The Remington Report