Home Health Leaders Commend CMS for Extending Safeguards to Prevent Fraudulent Behaviors and Protect Vulnerable Patients

Washington, DC – The Partnership for Quality Home Healthcare — a coalition of home health providers dedicated to developing innovative reforms to improve the program integrity, quality, and efficiency of home healthcare for our nation’s seniors — today commended the Centers for Medicare & Medicaid Services (CMS) for further extending safeguards designed to protect Medicare beneficiaries, prevent fraudulent behavior and save taxpayer dollars.

On Tuesday, CMS announced extending the moratoria on the enrollment of home health agencies in the Medicare program in the metropolitan areas of Miami-Dade, Fort Lauderdale, Detroit, Dallas, Houston and Chicago. Data show that many of these areas have historically been hotspots for fraud and abuse.

“We applaud CMS’ continued efforts to prevent fraudulent activity within the Medicare program and support targeted reforms to prevent aberrant behaviors and protect patients while saving taxpayer dollars,” stated Eric Berger, CEO of the Partnership for Quality Home Healthcare. “We are committed to advancing targeted program integrity solutions, which present a more sustainable approach to reform rather than arbitrary Medicare cuts and higher beneficiary costs that threaten patient access to care.”

The Partnership has developed a targeted program integrity reform proposal – Skilled Home Health and Integrity Program Savings (SHHIPS) – to prevent payment of aberrant claims by strengthening claims review processes, creating payment safeguards and tightening participation standards, including temporary entry limitations to prevent excess growth.

SHHIPS is based upon a successful policy included in the Affordable Care Act (ACA), which achieved a 70 percent reduction in outlier costs — from $1.2 billion in 2009 to $350 million in 2010 — and is on track to generate a total of $11 billion in taxpayer savings over the next decade. By capping Medicare outlier claims at 10 percent, the policy was effective in stemming what was considered to be unchecked fraud and abuse.