Medicare Home Health Agency Provider Compliance Audit: Bridge Home Health

Why OIG Did This Audit

• In calendar year 2023, Medicare paid home health agencies (HHAs) about $16 billion for home health services provided to about 2.8 million people enrolled in traditional Medicare. In that year, nearly 10,000 HHAs participated in Medicare.
• CMS determined through its Comprehensive Error Rate Testing program that the 2023 improper payment error rate for home health claims was 7.7 percent, or about $1.2 billion.
• This audit report, the first of a nationwide series of home health audits, examined whether Bridge Home Health complied with Medicare requirements.

What OIG Found

Bridge Home Health complied with Medicare billing requirements for 90 of the 100 home health claims we reviewed. For the remaining 10 claims, Bridge Home Health incorrectly billed Medicare for claims with unsupported codes, invalid face-to-face encounters, and skilled services that did not meet requirements.

• Six claims did not meet billing and coding requirements, resulting in a net underpayment totaling $291.
• Three claims did not meet face-to-face requirements, resulting in overpayments totaling $6,337.
• One claim did not meet skilled need requirements but did not result in an overpayment.

Bridge Home Health received net overpayments totaling $6,046 for the claims in the sample.

What OIG Recommends

We recommend that Bridge Home Health: (1) refund the $6,046 in overpayments to the Medicare program; (2) identify similar instances of noncompliance that occurred before, during, and after the audit period and determine the impact and return any overpayments to the Federal Government; and (3) strengthen its review of medical record documentation to ensure compliance with Medicare billing requirements.

Bridge Home Health concurred with our recommendations and provided detailed corrective actions it has taken since the audit period to address and prevent the types of findings identified during our audit.

---