Large-Scale Home Health Crackdown Begins in Massachusetts

Following a major surge in spending on home health care services, Massachusetts state officials have asked state Attorney General Maura Healey to investigate providers suspected of committing Medicaid fraud.

The news comes on the heels of the Centers for Medicare & Medicaid Services (CMS) extending its home health moratorium in several cities—though none in Massachusetts—for another six months.

Massachusetts Gov. Charlie Baker’s Executive Office of Health and Human Services referred 12 home health care agencies to the attorney general’s Medicaid Fraud Division after evaluating internal data and fielding consumer complaints that hinted at potential fraud, The Boston Globe reported.

“Our office is taking a hard look at the home health industry and is investigating the companies referred to us by MassHealth,” Cyndi Roy Gonzalez, a spokeswoman for the attorney general, said in a prepared statement. “Our focus is on rooting out the companies who are taking advantage of people at the taxpayers’ expense and ensuring that legitimate companies can continue to provide the necessary home supports people need.”

State officials did not reveal what type of misbehavior they suspect, nor did they name the agencies that they are investigating. Still, the state’s home health industry group recognizes that more oversight could be warranted.

“We’ve had a huge growth in number of home health agencies in the past five years, and we need to take some steps to address state oversight, whether its licensure or determination of need process,” James Fuccione, the legislative and public affairs director for Home Care Alliance of Massachusetts, told Home Health Care News.

Massachusetts’ costs for providing home health services have been skyrocketing. MassHealth, the state’s Medicaid program, is on track to spend over $755 million on home health services in the fiscal year ending June 30—an 82% increase from two years earlier, the Globe reported.

More than 80% of the spending growth since 2013 has been fueled by 62 companies that began working with the state during that time, state officials said. The state does business with 195 home health providers in total.

State officials said they are taking steps to control increasing spending, including mandating prior authorization before paying for home health services. Additionally, they have temporarily stopped doing business with new providers and are auditing home health agencies.

“We don’t think moratoria are heavy-handed, we think it’s justified, a reasonable method given where we’re at,” Fuccione told HHCN.

Home Care Alliance of Massachusetts welcomes more oversight of companies that are new to the market and driving up costs, he told The Boston Globe.

Still, the Alliance is worried that other steps state officials are taking, such as requiring prior authorization for services, could be burdensome for home health agencies and may hinder some patients from receiving needed medical care.

“It’s going to be an extra cost on agencies,” Fuccione told the Globe. “We are concerned that with a rate of reimbursement that’s below the cost of care already, this is going to lead to access issues. Our nurses may not want to perform these services anymore if agencies can’t pay them enough.”

Still, Fuccione is optimistic.

“There are always a lot more agencies doing things right than doing things wrong,” he told HHCN.

Written by Mary Kate Nelson