Progress | Impact

Stand Out & Deliver

In May 2016, CMS approved Palmetto GBA to pilot a Home Health Pre-Claim Review demonstration project to conduct pre-claim medical review of all home health claims in Illinois, Texas and Florida as an augmentation to Palmetto’s Jurisdiction M A/B MAC contract.


Palmetto GBA successfully

  • completed program start up in 73 days, including recruitment and staffing of more than 430 employees, developing necessary work processes, and implementing innovative technology to support the initiative
  • conducted extensive provider outreach and education
  • developed innovative approach to the submission of medical documentation via eServices portal


Why a pilot program?

There is extensive evidence of fraud and abuse in the Medicare home health program, particularly in Illinois, Texas and Florida.

Medicare Improper Payment Rate for Home Health Services