Home Healthcare Recommendations to Target Fraud and End

WASHINGTON — A report released yesterday by the Office of the Inspector General, CMS and Contractor Oversight of Home Health Agencies, underscores the need to reform Medicare’s current “pay and chase” practices and advance targeted program integrity reforms, according to the Partnership for Quality Home Healthcare.

The report, which examines fraud, waste and abuse and efforts to identify potential fraud and abuse, cites specific geographic areas prone to fraud, waste, and abuse. This confirms research commissioned by the Partnership, which has documented that home health fraud and abuse is isolated to select areas. Analyses of Medicare data commissioned by the Partnership demonstrate that just five states have more than half (53 percent) of all home health agencies, experience most of the provider and utilization growth, and consume nearly half (44 percent) of the nation’s total Medicare home health spend occurred in 2010.

“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.

The Partnership has been working with lawmakers and community leaders for more than a year on proposals to target fraud and abuse and strengthen the Medicare skilled home healthcare benefit. A package of suggested reforms ” called the “Skilled Home Healthcare Integrity and Program Savings” (SHHIPS) proposal ” includes provisions that would prevent overpayments before they happen by enforcing stricter entry rules and payment reforms to ensure less wasteful spending and criminal activity in the system.

The Partnership is also part of Fight Fraud First!, a coalition on behalf of seniors, persons with disabilities, military veterans, and family members to advocate for the elimination of waste, fraud and abuse in Medicare and Medicaid. Members of the FFF! coalition are urging lawmakers to find significant savings within Medicare and Medicaid without turning to across-the-board cuts or copayments that could harm the seniors and Americans with disabilities who rely on these valuable programs.

Nearly 3.5 million Americans nationwide currently receive Medicare home healthcare services for illnesses related to acute, chronic or rehabilitative needs. Data show skilled home healthcare is a clinically advanced, cost-effective and patient preferred option for American seniors.