CMS launches a pre-claim review demonstration in 5 states. Here are the key points.
Home health is a major part of the Medicare program, with more than $18 billion in Medicare payments distributed to 11,000-plus home health agencies (HHAs) across the United States in 2015. Of that sum, however, the Centers for Medicare and Medicaid Services (CMS) estimates that more than $10 billion of payments were improper.1
In fact, many of the largest fraud and abuse crimes in health care are committed within the home health setting, with the improper payment rate for home health services rising rapidly—from 17.3% to 59%—in the period from 2013 to 2015.2 The US Department of Health and Human Services' Office of Inspector General and the US Department of Justice collected close to $1 billion in civil and criminal actions in the home health setting from 2011 through 2015.1