Home Health Leaders Commend CMS for Launching New Fraud-Fighting Efforts

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 and Medicaid Services (CMS) for imposing a temporary moratorium on the enrollment of new Medicare providers in specific areas of the country, which are considered fraud “hot spots.”

The Partnership has long supported program integrity reforms that target fraud and abuse as a preferable alternative to across-the-board Medicare cuts and the re-imposition of burdensome out-of-pocket costs for home health beneficiaries.

“Targeted reforms are needed to strengthen the Medicare program, protect patients and defend taxpayers from fraudulent activities, which we believe is a better approach to Medicare reform than deep funding cuts and the re-imposition of a home health copay,” stated Eric Berger, CEO of the Partnership. “We urge the Secretary and CMS to advance more targeted reforms that can pinpoint aberrant billing practices and root out the bad actors from the Medicare program.”

Data show fraudulent and abusive billing practices in the home health sector are confined to a small number of isolated geographic areas of the country. Partnership analyses of Medicare claims data have found that nearly 90 percent of all aberrant Medicare home health spending is occurring in a small number of counties in just a few states. Therefore, the Partnership has put forth a package of targeted program integrity reforms known as the Skilled Home Health and Integrity Program Savings (SHHIPS) proposal 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 that placed a 10 percent cap on Medicare outlier claims to stem what was considered to be unchecked fraud and abuse. Adopted by CMS and included in the Affordable Care Act (ACA), this single reform 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.