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New OIG Report Shows That Insufficient Documentation is the Primary Cause of Medicare Fee-for-Service Improper Payments in FY2015

Posted on Monday, May 16, 2016 1:25 PM

A report by the Department of Health and Human Services Office of Inspector General (OIG) proves that insufficient documentation in home health is the main cause of Medicare fee-for-service improper payments. The report tracked a federal audit that concluded $268 million in 2015 was improperly billed Medicare.

In summary, HHS was unsuccessful in meeting a number of goals. Under IPIA, the Medicare fee-for-service error rate percentage should not have surpassed 10% in 2015. The rate was 12.9% for the fiscal year.

“HHS documented that insufficient documentation was particularly prevalent for home health claims,” the report findings read.

The OIG’s recommend the following for HHS:
• “Proactively take action” for the upcoming fiscal year
• Establish target rates for improper payments
• Improve communication between federal payers and providers

For the full article, click here.


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