Personal care aide and skilled nursing visit scheduled for same patient, same morning, same 2-hour window. Both visits EVV-verified. Claim from personal care agency denied on audit review — payer flagged the overlap 6 weeks after billing.
How it was caught
Discovered during a routine billing reconciliation when the denial came through. By that point, the visit was 6 weeks old and the aide had already been paid.
Outcome
Personal care agency had to write off the visit. No fraud finding — but the denial triggered a 90-day enhanced review period for that payer.
Impact
Estimated $340 write-off. 12 hours of staff time on the appeal. Enhanced review added 3–4 weeks to all subsequent claims for that payer.