Home Healthcare Program Integrity Reform Proposals Underscore Need for Increased Efforts to Curb Medicare Fraud and Abuse

WASHINGTON — A newly released plan for healthcare savings and reform by the National Coalition on Health Care (NCHC) underscores the need to strengthen the Medicare program through program integrity reforms such as those advanced by leaders in the home healthcare community, according to the Partnership for Quality Home Healthcare. The National Coalition on Health Care, a national alliance of consumers, providers and payers, released a plan last week that suggests $500 billion in spending reductions and health-related revenues can be achieved through a series of policy changes. According to the NCHC, the plan “offers federal policymakers a path forward to address the unnecessary growth in health care costs and to improve quality of care by transforming incentives for all actors in the health system.” One strategy presented within the plan is the reduction of fraud, errors and administrative overhead, for which NCHC members recommend increased fraud prevention and enforcement programs as well as the strengthening of federal anti-fraud authorities and infrastructure. While the group acknowledges that efforts to curb fraud and abuse have ramped up in recent years, it points out that more aggressive action is needed. In its report, NCHC recommends that “Fraud control should move away from the current “pay and chase” approach to a more proactive stance [and that] CMS should take a risk-based approach focusing pre-payment review on those services and goods most susceptible to fraud.” The home healthcare community has developed a program integrity reform plan called the “Skilled Home Healthcare Integrity and Program Savings” (SHHIPS) proposal that includes provisions supportive of NCHC’s recommendations. For example, the SHHIPS proposal would eliminate the possibility of overpayment by preventing payment of aberrant claims before they are made and by strengthening claims review processes and conditions of participation standards. The SHHIPS proposal is founded on the principle that policy solutions that target fraud and abuse can strengthen the Medicare program and achieve significant savings without harming innocent seniors or compliant providers. ”We fully support tough measures that target and prevent fraud and abuse and applaud NCHC for putting forth such a thoughtful plan,” said Senator John Breaux, senior counsel to the Partnership. “As fiscal cliff negotiations and broader budget deficit discussions resume this week, we urge Congress to strongly consider advancing targeted fraud fighting efforts, especially over across-the-board Medicare cuts or copayments that unfairly burden seniors and do not offer long-term solutions.”