Home Healthcare Community Commends Efforts to Combat Healthcare Fraud & Abuse

WASHINGTON — The Partnership for Quality Home Healthcare – a coalition of home healthcare agencies dedicated to developing innovative reforms to improve the program integrity, quality, and efficiency of home healthcare for our nation’s seniors — today commended the Departments of Justice and Health and Human Services for the healthcare fraud recovery reported in the Health Care Fraud and Abuse Control Program (HCFAC) Report.

“The outcomes reported today represent a positive step in the fight against fraud and abuse in our nation’s healthcare system,” stated Eric Berger, CEO of the Partnership. “Recovering payments that should not have been made is important, and we encourage lawmakers to advance policy reforms that would prevent such payments from being made in the first place.”

The Partnership strongly supports program integrity reforms designed to target fraudulent behaviors, which are unfairly harming innocent beneficiaries and honest providers. The Partnership and other home health community leaders have developed a reform proposal that targets fraud and abuse while safeguarding beneficiaries and providers. The “Skilled Home Healthcare Integrity and Program Savings” (SHHIPS) proposal includes targeted reforms to prevent the payment of improper Medicare claims.

In developing this proposal, home healthcare community leaders carefully examined data analyses undertaken by DOJ and HHS officials to pinpoint healthcare fraud hotspots. Medicare claims data presents strong evidence that isolated pockets of home health providers are abusing the Medicare program resulting in unnecessary and avoidable program spending. For example, analyses of 2011 Medicare claims data show that nearly 90 percent of all aberrant Medicare home health spending is occurring in a handful of counties in just five states.

The SHHIPS proposal is also based on a successful policy developed by the healthcare community in 2009, which placed a 10 percent cap on Medicare outlier claims to stem what was considered to be unchecked fraud and abuse. Adopted as part of the Affordable Care Act (ACA), this single reform achieved a 70 percent reduction in outlier costs, producing estimated savings of $853 million in 2010 — equivalent to $11 billion in savings over a ten-year period.

“The home healthcare outlier policy illustrates how targeted solutions can achieve significant savings while protecting innocent beneficiaries and compliant providers,” added Berger. “The Partnership looks forward to working with lawmakers to advance policy solutions to stop Medicare fraud and abuse before it ever takes place.”