St. Luke's Episcopal Church Home Care Program-Juana Diaz Properly Claimed Medicare Reimbursement for Home Health Services.

摘要

St. Lukes Episcopal Church Home Care Program is a private nonprofit organization that operates 14 facilities across Puerto Rico, including a facility in Juana Diaz, Puerto Rico that provides home health services throughout Juana Diaz and surrounding municipalities. The facility does business as St. Lukes Home Health Agency-Juana Diaz (Juana Diaz). Juana Diazs claims are processed and paid by National Government Services (NGS), the Medicare administrative contractor. For the period January 1, 2009, through June 30, 2010, NGS paid home health claims submitted by Juana Diaz, totaling $2,014,052. Our objective was to determine whether Juana Diaz claimed Medicare reimbursement for home health services in accordance with Federal requirements. We reviewed claims for home health services provided by Juana Diaz during the period January 1, 2009, through June 30, 2010. We did not perform an overall assessment of Juana Diazs internal control structure. Rather, we reviewed only the internal controls that pertained directly to our objective. We conducted fieldwork at Juana Diazs and St. Lukes Episcopal Church Home Care Programs offices in Ponce, Puerto Rico, and at physicians offices and beneficiary residences throughout Puerto Rico from March through October 2011.