Home Health Groups Applaud Latest Wave of CMS Moratoria

Both local and national home health care trade associations have voiced their approval of the recent announcement from the Centers for Medicare & Medicaid Services (CMS) that prevents the enrollment of new providers in the Medicare program for select cities. 

Last week, CMS announced its temporary moratoria on the enrollment of new home health agencies. in four metro areas: Fort Lauderdale, Detroit, Dallas and Houston. The moratoria also bars the enrollment of new ground ambulance suppliers in Philadelphia. 

CMS targeted areas after consulting with the Health and Human Services Office of Inspector General and the Department of Justice, which found that fraud trends warranted attention in certain geographic areas.

“This is the second wave of the agency’s use of this powerful tool to fight fraud and safeguard taxpayer dollars while ensuring patient access to care is not interrupted,” CMS stated in a release. 

Trade groups in the affected areas agree, especially the Texas Association for Home Care & Hospice (TAHC&C), which plays home to two metros covered in the CMS moratorium.  

“Those who would consider committing fraud in any Medicare program cannot escape the clear message form the Justice Department: Medicare fraud will not be tolerated and consequences await those who do,” said Rachel Hammon, executive director of TAHC&C. “Simply put, if you commit fraud you will be prosecuted.” 

Fraud not only permeates the home health industry, but healthcare in general. 

Recent findings from the Justice Department revealed healthcare-related fraud resulted in 137 cases filed, 345 individuals charged, 234 guilty pleas secured and 46 jury trial convictions in Fiscal Year 2013 alone. 

“TAHC&C supports efforts by regulators and authorities to implement and vigorously enforce integrity and accountability measures that identify and prosecute Medicare and Medicaid fraud in an effective and timely manner,” Hammon said. “It is critical that those who would commit fraud see clear consequences.” 

On a national scale, the National Association for Home Care & Hospice (NAHC) lauded the CMS efforts as “necessary” measures to bolster the integrity of home health in the Medicare program. 

“NAHC has advocated for a moratorium on the certification of new Medicare home health providers in certain areas of the country where an overabundance of providers leads to potential abusive practices,” said NAHC President Val J. Halamandaris. “The extension and expansion of the home health moratorium is a necessary and appropriate measure.”

The group also says it plans to continue working with CMS to establish home care as the benchmark of program integrity in Medicare.  

Improving program integrity for the home health industry is also one of the utmost priorities of The Partnership for Quality Home Healthcare, another industry trade group.

“We applaud CMS’ efforts to target the isolated instances of fraudulent activity within the medicare program and urge the agency to advance more pro-patient solutions that prevent aberrant behaviors rather than across-the-board cuts and higher beneficiary cost burdens that threaten patient access to care,” stated Eric Berger, CEO of The Partnership.

“Targeted program integrity solutions that protect patient access while saving taxpayer dollars are a much more sustainable approach,” he added.”

The Partnership has proposed a package of integrity reforms known as the Skilled Home Health and Integrity Program Savings (SHHIPS) proposal. 

SHHIPS aims to prevent fraudulent payment activity by strengthening claims review processes, creating payment safeguards and tightening participation standards, including temporary entry limitations.

CMS announced its first moratorium on new home health and ground ambulance supplier enrollment in the Medicare program in July 2013. The affected areas prohibited new home health provider enrollment in Miami and Chicago, as well as new ground ambulance suppliers in Houston. 

Written by Jason Oliva