OIG Report: Home Health VNA Overbilled Medicare By $15.5 million


CONTACT: Kristin Walter
(202) 898-0995

OIG Report: Home Health VNA Overbilled Medicare By $15.5 million

Washington, D.C. – A report released this week by the U.S. Department of Health and Human Services Office of Inspector General (OIG) found that Home Health VNA in Lawrence, Mass., overbilled Medicare $15,483,448 million from 2011 to 2012.  According to the OIG, 21 percent of the hospital’s Medicare claims were improperly billed.

According to the Council for Medicare Integrity, a nonprofit organization that advocates for proper Medicare billing, Home Health VNA’s improper billing rates are part of a nationwide problem.  The Medicare improper payment rate stands at 12.1 percent and has been above the legal billing error rate threshold of 10 percent for the past three consecutive years. During that time, Medicare overpaid hospitals and other healthcare providers $125 billion for services that were unnecessary or billed improperly.

Recently, the Medicare Trustees released a report warning that at current spending levels the program will be bankrupt by 2028 – just 12 years from now – causing many policymakers to have grave concerns about the future of the program.

In an effort to reduce wasteful spending within Medicare, the Recovery Audit Contractor (RAC) Program was put in place by Congress in 2009 to review Medicare FFS post-payment claims to identify and recover improper payments made to providers. Since then, Senator Claire McCaskill (D-MO), the Ranking Member on the U.S. Senate Special Committee on Aging, has credited the RAC Program with returning $10 billion back to the program and extending its life by two years. Unfortunately, new Centers for Medicare and Medicaid Services (CMS) rules have scaled back RAC reviews, now allowing a Medicare provider that bills erroneously 91percent of the time to have no more than 5 percent of their claims reviewed for accuracy.

“The Medicare insolvency date continues to trend in the wrong direction,” said Kristin Walter, spokesperson for the Council for Medicare Integrity. “There is a significant long-term shortfall that needs to be addressed to keep the program afloat. The government has great tools at their disposal that could help bolster the solvency and longevity of the program, but those tools are now being used at half capacity. It’s time to stop giving our tax dollars away to line the pockets of hospitals and instead recover them to be used to cover the future healthcare needs of our nation’s seniors.”

For more information, please visit: www.medicareintegrity.org.

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About the Council for Medicare Integrity
The Council for Medicare Integrity is a 501(c)(6) non-profit organization. The Council’s mission is to educate policymakers and other stakeholders regarding the importance of healthcare integrity programs that help Medicare identify and correct improper payments.

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