Epstein Becker Green (EBG) guided a home health agency through a Medicare claims audit conducted by the U.S. Department of Health and Human Services’ Office of Inspector General. The audit had originally indicated that 25 percent of our client’s claims did not meet the criteria for home health coverage due to beneficiaries allegedly not being homebound.
Following this audit, the Centers for Medicare & Medicaid Services sought to recover an extrapolated overpayment. Through a rebuttal process, the error rate was dropped to 4 percent, but the home health Medicare Administrative Contractor still calculated an extrapolated error rate. After a further rebuttal and appeal process guided by EBG, an Administrative Law Judge issued a decision fully favorable to our client, agreeing that the audit did not apply the homebound criteria correctly and eliminating the disputed overpayment.