A new home-health related item added to the work plan of the Department of Health and Human Services’ (DHS) Office of Inspector General (OIG) on focuses on incorrect billing claims.

The November 2025 work plan item, Incorrectly Billed Visit Units That Trigger Outlier Payments on Home Health Claims, aims to determine whether home health claims outlier payments complied with certain Medicare billing requirements.

This work comes after previous compliance work identified claims where home health providers incorrectly billed single-discipline visit units (greater than 8 hours) that resulted in overpayments equal to the outlier payment.

Medicare Administrative Contractors (MACs) pay outlier payments on home health claims for enrollees who incur unusually large costs that are determined by the visit units billed on the claim. Nationwide home health claims data for the most recent 30-month period shows that the average duration of a home health visit is 45 minutes.

OIG anticipates the work on this issue to be completed by fiscal year 2027.