Home Health Leaders Commend CMS for Improving Medicare Program Integrity

The Partnership for Quality Home Healthcare – a leading coalition of home health providers dedicated to improving the integrity, quality, and efficiency of home healthcare for our nation’s seniors – today commended the Centers for Medicare and Medicaid Services (CMS) for taking action that strengthens Medicare rules to better protect patients and taxpayers from the isolated instances of aberrant behavior which plague the Medicare program.

The new CMS safeguards will better prevent abusive billing practices by improving the agency’s ability to deny providers with unpaid Medicare debt from re-entering the Medicare program, revoking billing privileges for providers with a history of billing behavior that fails to meet Medicare standards, and suspending providers with a history of criminal activity. These provisions are expected to generate savings of more than $327 million annually.

“We applaud CMS for using its authority to more aggressively target Medicare fraud and abuse,” stated Eric Berger, CEO of the Partnership for Quality Home Healthcare. “As tens of thousands of Americans enter the Medicare program daily, program integrity reforms are critical to ensuring the solvency of the Medicare program and safeguarding access to quality healthcare for American seniors.”

Many of the measures outlined by CMS are similar to provisions included in the Skilled Home Healthcare Integrity and Program Savings Act (SHHIPS) put forth by the Partnership. The SHHIPS proposal includes concrete reforms that, like CMS’ action, would crack down on aberrant billing behavior and utilize criminal background checks to strengthen participation standards. Other SHHIPS measures include hard-wired safeguards to prevent the payment of aberrant claims, stronger claims review processes, and the implementation of temporary entry limitations to prevent excess growth.

SHHIPS is based upon the successful outlier payment limit, which was proposed by the home health community and implemented in 2010. This reform has achieved a 70 percent reduction in outlier claims reimbursement — 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 by 2019.

“Federal data demonstrate that incidents of fraud and abuse, such as excessive episode utilization, occur in just 25 out of the nation’s 3,143 counties,” added Berger. “Since aberrant behavior has been identified with such precision, it can and should be targeted and stopped. We look forward to working with CMS and Congress to build upon these successful steps and protect seniors and taxpayers alike.”