Case Study: Home Health Agencies recover millions in overpayments with SCIO Health Analytics

Home Health Agencies - Customer Case Study

Home Health Agencies were driving substantial member utilization for a top-five commercial carrier but the payer lacked the staff and clinical expertise to validate HHA billing accuracy. SCIO Health Analytics was engaged to address this challenge, bringing predictive analytics, OASIS-based review methods, and nationwide auditing capability to identify suspicious billing patterns and prioritize facilities for review.

SCIO Health Analytics implemented analytics-driven flags and deployed OASIS‑certified nurse auditors to review medical records for home‑bound status, documentation accuracy, and whether billed services were ordered and executed; findings were communicated to providers. The audits found errors in 70% of reviewed claims (with only 8% appealed), identified over $2 million in overpayments in the initial reviews, and projected recovery and savings exceeding $30 million annually once the program reached steady state.