Home Health Providers Praise Senate Panel’s Ongoing Anti-Fraud Initiative

The Partnership for Quality Home Healthcare applauds the Senate Finance Committee for exploring program integrity initiatives that the home health community has long pushed — including requiring home health agencies to establish compliance and ethics programs, and temporarily limiting new providers in areas of economic growth. These are among a laundry list of proposals included in the committee’s recently released report highlighting recommendations from stakeholders on how to fight Medicare and Medicaid waste, fraud and abuse.

“After working for more than a year to develop program integrity reforms for the Medicare home health benefit, we are encouraged to see many of our proposals highlighted by the Committee,” said Eric Berger, CEO of the partnership.

These recommendations, part of the partnership’s “Skilled Home Health and Integrity Program Savings,” are based on evidence that fraud and abuse in the home health sector is highly isolated and can be effectively combated through targeted solutions.

Though the lawmakers have not yet produced recommendations on the anti-fraud proposals, GOP Sens. Orrin Hatch (UT), Chuck Grassley (IA) and Tom Coburn (OK) have continued to question CMS on some of these issues, and have urged the agency to move forward with moratoria on home health providers in certain areas.

CMS has previously said that a moratoria would not do anything about already existing bad actors.

CMS program integrity chief Peter Budetti has said that CMS is moving forward with a probable fraud measurement pilot, though, to get a handle on the amount of fraud within the sector. Currently, CMS does not know exactly how much fraud is occurring throughout Medicare, as Budetti has said that the nature of fraud makes it difficult to quantify. The pilot, which CMS hopes to have up and running within the year, will use expert review and sampling to create a baseline for fraud within the home health sector. CMS said it its fiscal 2013 budget that the pilot was structured to look at both durable medical equipment and home health, but CMS spokespeople have since said the project was streamlined to begin looking at home health first.

The Finance Committee released its overview and summary of anti-fraud recommendations from stakeholders after having released a white paper compendium in February (see related story). The senators spearheading the effort — Senate Finance Chair Max Baucus (D-MT) and Finance members Hatch, Grassley, Tom Carper (D-DE), Ron Wyden (D-OR), and former Finance member Coburn — are working across agencies and committees to develop a refined list of proposals, according to a finance committee release.

The committee says the policy recommendations in the report will be further examined to determine if legislative action will be pursued.

The five primary areas of recommendations include addressing audit burden, enforcement, data management, beneficiary protection and improper payments. Many stakeholders highlighted problems with improper payments, and 83 percent of those stakeholders suggested policy reforms. Other stakeholders suggested that the committee look into reforming the auditing process to help relieve the audit burden on providers.

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