August 3, 2012

Home Healthcare Community Supports Targeted Reforms to Strengthen the Medicare Home Health Benefit

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Washington, DC — In response to a report released yesterday by The Office of the Inspector General (OIG), leaders from the home healthcare community reiterated their support for targeted Medicare reforms. The report, which aligns closely with policy solutions supported by the home healthcare community, provides recommendations for strengthening the Medicare benefit to prevent inappropriate billing practices through reforms including improved billing processes, prevention of aberrant claims payment, and a temporary moratorium on new provider enrollments in targeted areas.

The Partnership for Quality Home Healthcare, a national coalition representing more than 1,500 community- and hospital-based home health agencies nationwide, strongly supports efforts to improve the program integrity, quality and efficiency of the Medicare program. The home healthcare community has been working together for more than a year to develop policy solutions specifically designed to prevent abusive behaviors, including policies that seek to target fraud and abuse even more broadly than the OIG suggests in yesterday’s report. While these solutions, such as a targeted moratorium, mirror many of the OIG’s recommendations, they are also designed to apply nationwide to ensure inappropriate payments are prevented before they are made.

As noted in the OIG report, aberrant billing practices are largely concentrated to specific geographic areas. In a June letter to the Senate Finance Committee, the Partnership stated, “Federal data pinpoints where healthcare fraud and abuse is occurring. For example, Medicare claims data reveal that 60 percent of all the abuse in home healthcare relating to Medicare outlier claims in 2009 occurred in just two of the nation’s 3,143 counties. Similarly, Medicare data indicates that nearly 90 percent of all aberrant home health reimbursement occurred in a minority of counties in just five states.”
The home healthcare community previously advanced a reform limiting outlier claims, which has effectively reduced aberrant behavior and Medicare spending. Data generated by the Centers for Medicare and Medicaid Services (CMS) shows that this single payment reform relating to outlier claims — which was accepted and implemented beginning January 1, 2010 — achieved over $850 million in Medicare savings in 2010 alone, equivalent to nearly $11 billion in savings over a 10 year period. As a result, this policy serves as evidence that targeted program integrity reform can generate significant savings without impacting beneficiaries or cost-efficient providers.

The home healthcare community’s proposal is modeled on the successful outlier precedent that will be equally effective in strengthening the integrity of the Medicare program. Key components of the proposal include enhanced conditions of participation, claims validation processes, targeted payment integrity reforms and a moratorium on the entry of new providers in heavily saturated markets. These reforms have been shared with policymakers for consideration as a means for achieving significant savings without harming seniors’ access to care.

“What the OIG findings point to is the need for targeted reform to stop fraud and abuse before it happens,” stated Senator John Breaux, senior counsel to the Partnership for Quality Home Healthcare. “The home healthcare community has developed targeted reforms that build on its already-implemented outlier cap and that achieve savings for taxpayers without harming innocent seniors and clinicians. We look forward to working with leaders in Congress to make these targeted reforms a reality.”

Nearly 3.5 million Americans currently receive Medicare home healthcare services, which nearly 9-in-10 seniors prefer over care delivered in institutional settings. Many healthcare treatments that were once only available in a hospital or other settings are now being safely and effectively provided in patients’ homes by skilled clinicians.


The Partnership for Quality Home Healthcare was established in 2010 to assist government officials in ensuring access to quality home health services for all Americans. Representing more than 1,500 skilled home healthcare agencies nationwide, the Partnership is dedicated to developing innovative reforms to improve the quality, efficiency and integrity of home healthcare for seniors and disabled Americans. To learn more, visit and join the home health policy conversation on Facebook, Twitter and our blog.