A new study from the HHS Office of Inspector General (OIG) shows that some of the patient lists home health agencies supplied to surveyors were missing Medicare beneficiaries. Relying on agencies to supply the lists exposed a vulnerability that beneficiaries could be excluded from surveyors’ reviews.
"We also found that surveyors cannot comprehensively verify that HHA-supplied patient lists are complete at the time they conduct their surveys, creating a vulnerability that HHAs could exploit to conceal fraudulent activity or health and safety violations,” the study states. “However, existing data sources may be useful tools for both surveyors and CMS.”
OIG conducted the study because home health “is a program area susceptible to fraud, waste and abuse.” And while state surveyors or accrediting organizations conduct onsite surveys at least every 36 months, surveyors use agency-supplied lists to select patients for review. This raises the concern that agencies “could manipulate these lists to avoid scrutiny of certain patients,” the study states.
In its analysis, OIG selected high-risk agencies in California, Florida and Texas and collected agency-supplied patient lists that surveyors used in recent surveys. Those lists were compared to Medicare claims data so that missing beneficiaries could be identified.
Among the potential strategies OIG cites to mitigate risk:
  • Create new OASIS-based reports or adapt existing reports for surveyors. These reports could match the parameters of patient lists that agencies provide. And those reports could be available to surveyors at the time of the survey. “While such reports would be limited by the absence of some recently admitted patients, they would represent an improvement over relying on [agency]-supplied patient lists alone,” the study states.
  • Conduct retrospective reviews using claims data.
  • Direct surveyors to monitor agency staff as they retrieve patient lists.
  • Direct surveyors to confirm that patient lists include a subset of active patients. In other words, CMS could have surveyors interview a randomly selected nurse or aide so the surveyor could get information about that agency employee’s patients. The survey could check those patients’ information against the agency-supplied lists. “CMS staff presented this strategy to OIG as one that it may explore,” the study states. “While the approach would not comprehensively verify HHA-supplied patient lists, we agree that it would provide greater assurance that the lists are complete.”
Related link: View the full study at https://oig.hhs.gov/oei/reports/oei-05-16-00510.pdf.