The OIG Fiscal Year 2014 Work Plan and Home Health Agencies

In the Office of Inspector General (OIG) Fiscal Year 2014 Work Plan, there are several provisions with respect to home health agencies and compliance.   

Billing Issues

One area of focus includes home health agency billing practices, as a prior OIG report found that a quarter of all home health agencies had “questionable billing.”  In addition, the OIG noted that the Centers for Medicare & Medicaid Services (“CMS) designated newly-enrolled home health agencies as “high-risk providers” related to a history of fraud, waste, and abuse.  The OIG also cited a figure that since 2010, “nearly $1 billion in improper Medicare payments and fraud has been identified relating to the home health benefit.” 

Background Checks and Health Screening

Another area of concern with respect to home health agencies, includes whether the agencies are conducting exclusion or criminal background checks on applicants and employees.  From a May 8, 2013 Special Advisory Bulletin on the effect of exclusion from participation in federal health care programs, we recommend at a minimum that home health agencies are checking the List of Excluded Individuals and Entities (LEIE) upon hire, and at least annually thereafter.

In addition, the OIG noted that Medicaid home health agencies are also required to screen their workers for such vaccinations as hepatitis and influenza, and compliance with this requirement will also be reviewed.

Conditions of Participation

Finally, the 2014 work plan is going to address whether billing providers have met the Conditions of Participation for home health agencies, including that the services are provided at the patient’s place of residence, and on a physician’s orders as part of a written plan of care, reviewed by a physician every 60 days.   Further, the care provided must require only intermittent, and not full-time skilled nursing care. 

Temporary Moratoria

The fiscal year 2014 work plan is reflective of CMS’ recent efforts with respect to alleged fraud by home health agencies.  In July 2013, CMS issued temporary moratoria on the enrollment of home health agencies in two major metropolitan areas:  the Chicagoland area, and the Miami, Florida area.  On January 30, 2014, CMS announced that in addition to these two geographical areas, it has also extended the moratoria to four other metropolitan areas:  Fort Lauderdale, Florida, Detroit, Michigan, Dallas, Texas, and Houston, Texas.  The moratoria are in effect for a six-month period, which may be extended by CMS by issuing another notice in the Federal Register. 

The OIG and CMS’s concerns regarding fraud and abuse are reminders to home health agencies to revisit their compliance efforts, and ensure that the agencies are meeting all requirements under both federal and state laws. 

If you have any questions regarding either the OIG work plan, general compliance with federal and state regulations, or the temporary moratoria, please contact either Charles MacKelvie ( or Jaya White (