HHS OIG Releases Semi-Annual Report to Congress
The U.S. Office of Inspector General (OIG) of the Department of Health and Human Services (HHS) has released its Semi-Annual Report to Congress which summarizes its activities and findings for the six-month period that ended Sept. 30th. The report details how programs that deliver health care in non-institutional settings continue to be increasingly popular and how over half of all spending on Medicaid long-term services and supports is now for home and community based services (HCBS), exceeding Medicaid spending on institutional services. OIG expanded its focus on the quality and safety of care provided to vulnerable populations, including those in non-institutional settings.
Included in this OIG report is a Nationwide Analysis of Common Characteristics in OIG Home Health Care Fraud Cases. OIG reviewed Medicare claims data from calendar years 2014 and 2015 to assess the national prevalence and distribution of selected characteristics commonly found in OIG-investigated home health fraud cases. Upon their review of the Medicare claims data, OIG found five common characteristics:
- High percentage of episodes for which the beneficiary had no recent visits with the supervising physician;
- High percentage of episodes that were not preceded by a hospital or nursing home stay;
- High percentage of episodes with a primary diagnosis of diabetes or hypertension;
- High percentage of beneficiaries with claims from multiple HHAs; and
- High percentage of beneficiaries with multiple home health readmissions in a short period of time.
Please note that in its analysis, OIG identified 27 hotspots in 12 states that had some of the characteristics commonly found in OIG home care fraud cases. New York was one of the 12 states.
Contact: Cheryl Udell, cudell@leadingageny.org, 518-867-8871