Home Healthcare Community Calls for Tough, Targeted Reforms to End Medicare Fraud and Abuse

WASHINGTON, DC — On the occasion of the Senate Finance Committee’s important hearing on Medicare fraud and abuse, the Partnership for Quality Home Healthcare reiterated its call for tough action targeting fraud and abuse. The home healthcare community has developed targeted program and payment integrity reforms specifically designed to protect beneficiaries, cost-efficient providers and taxpayers alike by preventing fraud and abuse before it occurs.

Leaders in the home healthcare community have been working together for more than a year to develop policy solutions that can be effective in identifying and stopping fraud and abuse. The community’s proposal, which calls for targeted payment integrity reforms (such as episode and low utilization payment adjustment (LUPA) limits), and program integrity improvements (such as enhanced conditions of participation and claims validation processes), has been shared with policymakers for consideration as a means for achieving significant savings without harming seniors’ access to care.

A recent analysis of Medicare data indicates that 60 percent of all outlier abuse in 2009 occurred in just two counties and nearly 90 percent of all aberrant billing in the Medicare home health benefit occurred in counties in just five states. This analysis and MedPAC’s identification of 25 counties with high rates of Medicare utilization demonstrate that fraud and abuse have been carefully identified and, therefore, can be effectively targeted.

“Federal data pinpoints where healthcare fraud is occurring. As a result, the federal government can target fraudulent activity, preventing it from occurring in the first place and protecting seniors and taxpayers alike,” said Chairman Billy Tauzin, senior counsel to the Partnership for Quality Home Healthcare.

“To help Congress do so, the home healthcare community has proposed a tough, targeted solution to attack this targeted problem while safeguarding patients and honest providers. Based on recently released Medicare data, just one of the community’s provisions will save taxpayers $11 billion over 10 years. Just as important, the community’s reform proposal will stop fraud before it happens so that criminal acts are blocked before they can occur.

“We applaud Senators Max Baucus and Orrin Hatch for their efforts to put an end to Medicare fraud and abuse, which we think can be achieved through targeted reforms. Together, we can secure seniors’ access to clinically advanced, cost effective, patient preferred home healthcare ” and stop the bad actors who are preying on current weaknesses in the Medicare and Medicaid programs,” concluded Tauzin.