U.S. Department of Health and Human Services (HHS) Secretary Xavier Becerra fielded questions in a House Ways & Means committee hearing on Capitol Hill Wednesday, a few of which were pointed at concerns around potential fraud in home health.
Rep. Michelle Steel (R-Calif.) grilled the secretary about an apparent lack of progress on curbing certifications for bad actors.
Steel also pointed to a potential discrepancy in the way home health agencies are accounted for, and how HHS and the the Centers for Medicare & Medicaid Services (CMS) tracks enrollment data.
The system in question is Quality, Certification, and Oversight Reports — also known as QCOR.
QCOR is an online reporting platform under CMS that allows the public to access timely and summarized data about providers and suppliers of both Medicare and Medicaid services. Information in QCOR includes provider names, addresses, sizes, ownership details and other general information.
According to Rep. Steel’s questioning, QCOR has not updated its information since early 2021 due to a system migration issue.
“My question here is, the public has a right to know what providers are enrolled in the Medicare program and it is completely unacceptable that the public-facing website has not been operational since 2021,” Steel said. “Can you explain why this has occurred and why the agency proceeded with enrolling over 800 new home health agencies in California?”
Though he pledged more detailed responses at a later date, Becerra told lawmakers that he was mostly unaware of what Steel was referring to and pledged to continue program integrity efforts.
“Congresswoman, what you’re presenting to me is something that I’ve not heard so I’ll have to get back to you on that,” Becerra said. “I will tell you, just as we were in our discussion about hospice care, home health care — which is a growing industry as well — is something that we’re trying to monitor more closely. We are constantly doing program integrity work in this field as well. We could try to respond more specifically to any questions you have, but what you’ve just mentioned does not sound familiar to me.”
In recent years, there has been a significant increase in the number of hospice providers enrolled in Medicare, particularly in Arizona, California, Nevada and Texas.
In some instances, multiple hospices have been operating from the same address without a corresponding increase in the population of eligible patients.
The surge in enrollment has raised concerns about potential fraudulent activities. One county in particular is once again in the spotlight: Los Angeles County.
What Steel referred to during Wednesday’s hearing was a discrepancy between QCOR figures and raw enrollment data sets made public by CMS.
There are 11,353 home health agencies enrolled in the QCOR data set and 11,577 enrolled in CMS’ raw data set.
Even though the totals aren’t far off from each other, there has been a significant shift in the locations of the home health agencies.
CMS enrolled 839 home health agencies from 2021 to 2023, according to data shared with Home Health Care News on background. Of those, more than 700 were listed in Los Angeles County alone.
However, there is no information about those agencies in the public-facing QCOR website.
“I can make sure that we give you a more complete answer than what I can give you right now,” Becerra said during the hearing. “Some of [these bad actors] go out and do things that are against the law or do things fraudulently, there’s no doubt that’s one of the reasons why under Medicare or Medicaid we are constantly trying to root out that fraud.”
