Home Health Providers Doubt New Demo Would Stem Fraud, Urge Caution

Home health providers question how CMS’ revamped home health demonstration will help stem fraud when the agency has recognized the high improper pay rate in that sector appears to be driven largely by paperwork problems, and suggest CMS look at alternatives. But the providers also ask the agency to clarify key aspects of the planned demo in the event it moves forward.

The National Association for Home Care and Hospice raises questions about CMS’ authority to implement the Review Choice Demonstration, given that the group says the prior version of the demonstration didn’t find any fraud. The Partnership for Quality Home Healthcare says CMS should publicly share any information it has that shows the old demonstration successfully reduced fraud or it should say why the new one would be any more effective.

“[W]e do not believe that pre-claim review, or post-claim review, policies will stop bad actors who are intent on defrauding the Medicare program. Instead, bad actors will continue to submit false information that satisfies the new requirements. It is difficult to imagine that this demonstration represents an effective measure for investigating and prosecuting fraud in the home health benefit,” the Partnership for Quality Home Healthcare says in comments on the demo, adding that CMS should continue to consider other opportunities that would more effectively target home health fraud.

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