Home Health Leaders Urge Action to Target and Combat Waste, Fraud and Abuse in the Medicare Program

Washington, DC – 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 – commended the House Energy and Commerce Subcommittee on Oversight and Investigations for drawing increased attention to the need for greater fraud prevention programs within the Medicare program.

“We commend Chairman Tim Murphy and his colleagues for continuing to seek solutions that will prevent wasteful spending in one of our government’s most important programs,” stated Eric Berger, CEO of the Partnership for Quality Home Healthcare. “As the Medicare population continues to grow, it is essential to ensure the security of the Medicare program for generations to come.”

Data show Medicare fraud and abuse in the home health sector are isolated to pockets of the country. For example, out of the nation’s 3,143 counties, the Medicare Payment Advisory Commission (MedPAC) has identified just 25 counties in a total of five states where the majority of abuse impacting the home health benefit is occurring. As a result, the Partnership has long sought targeted program integrity measures to prevent fraud and abuse in these isolated areas of the country.

In support of this effort, the Partnership has put forth the Skilled Home Health and Integrity Program Savings (SHHIPS) proposal, which would move Medicare away from the failed “pay and chase” model by preventing payment of aberrant claims through firm payment safeguards, strengthened claims review processes, and tighter participation standards, including temporary entry limitations to prevent excess growth. SHHIPS also includes important credentialing requirements, criminal background checks, and a compliance program modeled on the Inspector General’s guidelines. Estimates from Dobson | DaVanzo & Associates and Douglas Holtz-Eakin demonstrate the payment reforms alone could save more than $15 billion over 10 years by preventing inappropriate outlays.

The Partnership joined with leading organizations like AARP, Easter Seals, and the National Association for Uniformed Services in an initiative urging Congress to make program integrity reform a top priority. The Fight Fraud First! coalition urges action to combat waste, fraud and abuse, rather than across-the-board cuts which impact innocent seniors and compliant providers.

Finally, the Partnership supports value-based purchasing and post-acute care reform, such as the recently introduced Bundling and Coordinating Post-Acute Care (BACPAC) Act of 2014. By encouraging the delivery of high-quality, cost-effective care, these innovative reforms would eliminate opportunities for unscrupulous individuals to take advantage of the Medicare program through wasteful, abusive and fraudulent activities.

“We applaud the Committee for its work on this critical issue and call on Congress and the Centers for Medicare and Medicaid Services to take targeted action to prevent payment of aberrant claims by supporting policies such as SHHIPS, value-based purchasing, and BACPAC,” added Berger. “Rather than continuing to impose indiscriminate across-the-board cuts, such as the 14 percent rebasing cut to home health that took effect January 1, we urge lawmakers to enact targeted solutions that will preserve and strengthen the integrity of the Medicare program.“

Nationwide, nearly 3.5 million senior and disabled Americans rely on the Medicare home health benefit for clinically advanced, cost-effective and patient preferred home healthcare.