OIG Keeps Pressuring CMS to Impose Fraud-Prevention Sanctions on Home Health Agencies

The past several years have seen a huge amount of Medicare fraud among home health agencies, and in response the Office of Inspector General (OIG) has consistently pressured the Centers for Medicare & Medicaid Services (CMS) to impose sanctions as a preventive measure, reports Healthcare Finance News

Back in 1987, the Omnibus Budget Reconciliation Act (OBRA) directed CMS to implement intermediate sanctions for noncompliant home health agencies (HHAs). OBRA specified that the intermediate sanctions CMS created should include civil money penalties, payment suspension and appointment of temporary management. While there is a corrective process for noncompliant HHAs, the only HHA sanction option CMS currently has at its disposal is termination, an option it doesn’t use often.

Even though the number of Medicare-certified HHAs has seen a 59 percent increase between 2002 and 2009, CMS still has not issued a final rule for intermediate sanctions. It did issue a Notice of Proposed Rulemaking in 1991 but later withdrew it.

HHAs are aware that a proposed rule on intermediate sanctions may be issued soon – by some reports, in September – so there is some concern within the industry, said Mary St. Pierre, vice president, regulatory affairs, the National Association for Home Care and Hospice, about what additional burdens the new rule may add.

“Agencies now have condition levels, they are writing their plan aggression, they are being resurveyed, they are staying in the program and so they would look on this as an additional burden,” she said. “Having to either pay a fine or have some sort of management over them or whatever else CMS comes up with.”

Although home health agencies aren’t exactly excited about the possibility of more red tape, they recognize their industry could benefit from increased CMS oversight, the article says.

Read more at Healthcare Finance News.

Written by Alyssa Gerace

Alyssa Gerace



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