Review of Selected Paid Claims with Therapy Services Submitted to Medicare by Total Patient Care Home Health, LLC for the Period October 1, 2002, through September 30, 2003

EXECUTIVE SUMMARY:

Our objective was to determine whether selected home health claims that included therapy services provided by Total Patient Care Home Health, LLC (Total Patient Care) to Medicare beneficiaries met Federal requirements and were appropriately paid.  Home health episodes with 10 or more therapy services result in an increased payment to home health agencies.  A medical record review determined that 22 claims contained therapy services that were not reasonable.  Projecting the results of the overpayments in our random sample to the universe, the provider received an estimated $63,425 in overpayments for claims billed to Medicare.

We recommended that Total Patient Care work with the Regional Home Health Intermediary to reimburse the Medicare program $63,425 for unallowable therapy services, identify and submit adjusted claims for Medicare overpayments received subsequent to our audit period, and strengthen controls to ensure that the therapy services provided are reasonable and medically necessary.  In response to our draft report, Total Patient Care agreed with our findings.