A Michigan-based home health care provider that serves patients in Indiana and Illinois received an estimated $10.5 million in Medicare overpayments during 2014 and 2015, according to a recently released federal audit.
The inspector general for the U.S. Department of Health and Human Services claims Great Lakes Home Health Services Inc. incorrectly billed Medicare for services to beneficiaries who either were not homebound and/or not in need of skilled services.
According to the report, 38 of the 100 home health claims sampled as part of the audit did not comply with Medicare billing requirements.
Extrapolating that result to Great Lakes' 22,511 total claims worth $69,745,515 during the two-year period equates to $10,486,922 in overpayments, the audit said.
The inspector general is requesting that money be refunded to the Medicare program.
Great Lakes CEO Adam Nielsen vigorously disputed the purported overbilling in a written response to a draft version of the audit.
Nielsen said the inspector general's medical reviewer did not apply Medicare's homebound requirements correctly, and confused the distinctions between services provided by physical and occupational therapists and those provided by home caregivers.
"We are responsible stewards of the Medicare program under which we operate, and we have always fostered a culture of compliance — it is a central pillar to our company," Nielsen said.
"Our patients are individuals living with disabilities, and older Americans who want to age in place safely and comfortably. The populations we serve are among the most vulnerable beneficiaries in the Medicare program — underscoring the importance of seamless, quality home health. We do not take this responsibility lightly."
The inspector general said it adjusted some of its findings based on Great Lakes' response to the draft audit.
But it maintains that the findings and recommendations in the final audit are valid.
Great Lakes operates Great Lakes Caring facilities, offering home health and/or hospice services, in the Indiana cities of South Bend, Elkhart, Fort Wayne, Kokomo, Lafayette, Plainfield and Terre Haute. It also provides home health services in Palos Heights, Illinois.
According to the audit, Medicare paid home health agencies nationwide approximately $18 billion for home health services in 2016.
Testing by the Centers for Medicare and Medicaid Services determined 42 percent of those payments, totaling $7.7 billion, were made in error.
The audit noted that even though payments for home health services accounted for just 5 percent of Medicare fee-for-service spending, improper payments to home health agencies comprised 18 percent of the $41 billion in total improper payments.
In response, the report said the inspector general is using computer matching, data mining and data analysis techniques to identify home health agencies at risk for noncompliance with Medicare billing requirements and auditing their past claims.