Home Health Leaders Call for Targeted Program Integrity Reforms to Prevent Medicare Fraud

WASHINGTON, DC – On behalf of the Partnership for Quality Home Healthcare – a coalition of community- and hospital-based home healthcare agencies dedicated to developing innovative reforms to improve the program integrity, quality, and efficiency of home healthcare for our nation’s seniors – Chairman Billy Tauzin (R-LA) and Senator John Breaux (D-LA) made the following statement:

“Yesterday’s announcement that the Medicare Fraud Strike Force has charged nearly 100 individuals for allegedly defrauding the federal government for $223 million should prompt immediate action by lawmakers and stakeholders to advance policies that stop Medicare fraud and abuse before it takes place.

“The government’s own data show that abusive billing practices in home health occur in isolated parts of the country where excessive Medicare utilization is taking place. Nearly 90 percent of all improper payments for home health services are occurring in a small number of counties in just five states. Therefore, policymakers should undertake action to address fraud and abuse in a targeted manner.

“Recognizing the critical need to prevent taxpayer dollars from entering criminal hands, the Partnership has been working for more than a year to develop targeted reforms to combat waste, fraud and abuse.

“Reforms called for in the “˜Skilled Home Health and Integrity Program Savings’ proposal include beneficiary protections that prevent criminals from entering the system and payment safeguards that confirm the accuracy of filed claims to ensure validity prior to payment. Targeted measures have proven to save money, and could have potentially prevented the $51 million in fraudulent payments made to the Miami-based scheme uncovered yesterday.

“As lawmakers look for federal savings, we urge them to take a hard look at how much money is being lost to fraud and abuse and address this national dilemma before asking seniors and honest providers to pay the price.

“We commend the Medicare Fraud Strike Force for rooting out these criminals and look forward to working with lawmakers in Congress to advance reforms that address weaknesses in the Medicare program that allow fraud and abuse to threaten America’s seniors, the Medicare program and the nation’s taxpayers.”