OIG Report Recommends Home Health VNA Repay $15 million to CMS

In a final report issued last week, the OIG’s Office of Audit Services has found that Home Health VNA — a HCANH member based in Lawrence, MA — received Medicare overpayments of more than $15 million in 2011 and 2012.  The Office reviewed 497 claims, of which 105 were found to not comply with Medicare billing requirements. The amount overbilled was $314,406. Specifically, the Office found that beneficiaries were not homebound, did not require skilled services, had missing or insufficient physician documentation, or in one instance, a claim contained an incorrect HIPPS payment code.

The Office used an extrapolation algorithm to determine that Home Health VNA received more than $15 million in overpayments during the audit period.  It recommended that HHVNA should repay $6,348,971 for claims paid within the 3-year recovery period, and another $9,134,477 that is outside the recovery period but subject to the 60-day repayment rule.

Home Health VNA’s CEO John Albert responded to a draft report with a letter (available online at the end of the OIG report), disagreeing that HHVNA materially failed to comply with billing requirements.  “We strongly believe once we are given the opportunity to challenge these findings, we will be successful and the findings will be overturned.” Albert also shared an Open Letter to the Community this week.

A letter to the community from John Albert, President and CEO of Home Health VNA