OIG resolves cases against home health agencies

In first quarter of fiscal year 2021, approximately 61 percent of referrals the OIG Fraud Hotline sent to the Provider Investigations unit (PI) concerned home health care. Nearly half of PI's preliminary investigations for the quarter involved personal care attendants.

PI investigates and reviews allegations of fraud, waste and abuse committed by Medicaid providers who may be subject to a range of administrative enforcement actions including education, prepayment review of claims, penalties, required repayment of Medicaid overpayments, and/or exclusion from the Medicaid program. The sample cases below reflect a variety of outcomes.

The OIG settled a case in September against a home health agency located in Houston. This case was referred to the OIG from the Texas Office of Attorney General – Medicaid Fraud Control Unit. The provider employed a personal care attendant who was misusing the electronic visit verification system and logging hours that they could not have worked. The provider fully cooperated and responded by identifying all hours that could be related to the personal care attendant’s acts. The provider offered to pay $18,609 to resolve the identified hours.

A case settled in October concerned a home health care provider in San Antonio. The provider was found to have employed a personal care attendant to provide personal attendant services to a patient. However, it was discovered that the employee, by self-admission, did not provide any attendant services to the patient but did submit time sheets and receive compensation.

The provider worked collaboratively with the OIG and took the initiative to improve its policy and practices on conducting proper and routine home visits and communication with clients. To resolve the case, the provider agreed to a settlement of $76,697.

The OIG settled a case in September against a home health agency located in McAllen. The provider offers telehealth services but was unable to provide adequate documentation for a number of claims to support that they took the clients’ vital readings and forwarded them to the appropriate party. The provider collaborated with the OIG to implement new record keeping procedures. The provider agreed to pay $12,731 to resolve the unsupported claims.

The OIG has fraud prevention reminders for providers and attendants in this website’s resources section.