AGA Home Health, Inc.
Outcome
AGA Home Health self-disclosed and settled for $77,817.56 for submitting Medicare claims for home health services that were medically unnecessary and lacked medical documentation.
Details
AGA Home Health (Utah) — Medically Unnecessary Services / Lack of Documentation
Outcome: Self-disclosed and settled for $77,817.56 for submitting Medicare claims for home health services that were medically unnecessary and lacked the required medical documentation.
AGA Home Health, Inc., a Utah home health services provider, submitted Medicare claims for home health services that were not medically necessary and lacked proper supporting documentation. The organization voluntarily disclosed this conduct to HHS-OIG, resulting in the March 8, 2018 settlement of $77,817.56.
How Crucible Prevents This
Crucible's medical-necessity documentation enforcement hooks would flag home health claims without supporting medical documentation; a pre-submission compliance gate requiring a physician-signed plan of care with documented medical necessity for each admission would prevent billing for undocumented services.
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