Home Health Regulatory Compliance
Home health agencies, hospice providers, and personal care services.
38,942
Total Enforcement Actions
31,701
Actions This Year
—
Total Penalties Tracked
38,942
Critical / High Severity
Regulatory Overview
Home health agencies (HHAs) certified under Medicare must comply with 42 CFR Part 484 — the Conditions of Participation. CMS surveys can result in denial of payment for new admissions (DPNA), CMPs, or termination. The OIG has identified home health as a high-risk area for Medicare fraud, particularly for services billed without supporting documentation or for patients who do not qualify for homebound status.
Primary Enforcement Focus
CMS CoP surveys, OIG homebound status audits, and Recovery Auditor (RA) claim reviews. ZPIC/UPIC contractors conduct targeted investigations of suspected fraud.
Common Violation Patterns
Homebound Status Documentation
The #1 ZPIC/RA finding. Billing Medicare for patients who do not meet homebound criteria or whose records do not support it.
Aide Supervision Failures
Required supervisory visits by RN/therapist not conducted, inadequate aide competency evaluations.
Plan of Care Deficiencies
Physician-signed plan of care missing or not updated at required intervals. Skilled service not documented to support billing.
OASIS Coding Errors
Upcoding OASIS items to inflate case-mix-adjusted payment. Regularly audited by CMS and RA contractors.
Enforcement Actions — Home Health
Violations Signal Board
Latest Home Health NewsAll
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New Day CEO Kathy Poland Prioritizes Operations Over M&A
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Key Regulations
42 CFR Part 484 — HHA Conditions of Participation
Plan of care requirements, patient rights, skilled service documentation, aide supervision, and OASIS data accuracy.
OASIS Data Accuracy (42 CFR 484.55)
Outcome and Assessment Information Set must be completed accurately. Improper OASIS coding leads to overpayment and recoupment.
Medicare Homebound Status Requirements
Patient must be homebound (leaving home requires considerable effort). Failure to document homebound status is the top HHA audit finding.
HIPAA 45 CFR Parts 160 & 164
Applies to all PHI including OASIS data, care plans, and aide visit notes.
State Home Care Licensing
States independently license HHAs and may impose staffing, supervision, and documentation requirements beyond CMS minimums.