OIG: Insufficient home health & SNF claims documentation led to payment errors

A May 2016 Office of the Inspector General (OIG) report found that insufficient documentation was a serious cause of improper payments for both home health claims as well as skilled nursing facility claims in FY2015. The report, “US Department of Health and Human Services Met Many Requirements of the Improper Payments Information Act of 2002 but Did Not Fully Comply for Fiscal Year 2015” provides the results of an audit of HHS compliance with improper payment reporting requirements.

While the report found that HHS met many compliance requirements, it noted that the Medicare Fee-for-Service error rate percentage was greater than 10% for FY2015, which means the Agency was not in compliance with requirements. The primary causes for the 12.09 percent error rate were listed as insufficient documentation and medical necessity errors. Home health claims were found to have extremely high levels of insufficient claims documentation for medical necessity, with a 7.5 percent increase from FY2014 to FY2015. The report also found that improper SNF claims documentation increased by 4.10 percent in that same time period.


Read the full OIG report here.

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