CMS Again Bans New Home Health Agencies in Fraud Hotspots

The new year will not bring new home health agencies to Florida, Illinois, Michigan, or Texas. The Centers for Medicare & Medicaid Services (CMS) is once again extending a moratoria on new HHAs in those states.

CMS first barred new Medicare-certified home health agencies in select counties in 2011, under authority granted by the Affordable Care Act. Since that time, the agency has repeatedly extended the ban on new providers and expanded the moratoria to whole states. The scope also has been expanded to bar new HHAs from being certified for Medicaid and the Children’s Health Insurance Program in the selected states.

The latest six-month extension was announced in a Federal Register entry Monday.

The purpose of the moratoria is to combat fraud, waste, and abuse. The affected states all were identified as fraud hotspots.

“CMS relied on law enforcement’s longstanding experience with ongoing and emerging fraud trends and activities through civil, criminal, and administrative investigations and prosecutions,” the Federal Register entry states. “CMS’ determination of a high risk of fraud, waste, or abuse in these provider and supplier types within these geographic locations was then confirmed by CMS’ data analysis, which relied on factors the agency identified as strong indicators of risk.”

State partners such as Medicaid agencies supported the extension and determined that it would not prevent beneficiaries from accessing care, according to the entry.

The temporary moratoria does not prevent an HHA from changing ownership, in most cases, and does not prevent changes in location for existing practices.

Home health provider groups have sharply criticized CMS for taking an overly broad approach to combating fraud through initiatives such as pre-claim review. However, organizations including the National Association for Home Care & Hospice (NAHC) and the Visiting Nurse Associations of America (VNAA) generally have supported the moratoria, saying that they recognize the need to root out bad actors.

Written by Tim Mullaney

Tim Mullaney on Email
Tim Mullaney
If he’s not in the newsroom, Tim likes to be on the tennis court or traveling to a new destination. Recent highlights include Sri Lanka and Iceland.

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