New CBO Report Underscores Need for Medicare Program Integrity Reforms

Washington, DC – The Partnership for Quality Home Healthcare – a leading coalition of home health providers dedicated to improving the integrity, quality, and efficiency of home healthcare for our nation’s seniors – today called for greater support for fraud prevention programs within the Medicare program in response to a Congressional Budget Office (CBO) report released Monday, which estimates federal spending for the programs’ benefits would be reduced by legislation that would provide either additional funding or new authority to reduce fraud.

The CBO report, “How Initiatives to Reduce Fraud in Federal Health Care Programs Affect the Budget,” examines how legislation designed to reduce fraud can also help eliminate waste and abuse. The report states that program integrity reforms could reduce fraud, waste, and abuse, therefore improving the accuracy of Medicare payments overall.

Home health leaders have long sought targeted program integrity measures to prevent fraud and abuse. The Partnership has developed a targeted program integrity reform proposal – Skilled Home Health and Integrity Program Savings (SHHIPS) – to prevent payment of aberrant claims by strengthening claims review processes, creating payment safeguards and tightening participation standards, including temporary entry limitations to prevent excess growth.

SHHIPS is based upon a successful policy included in the Affordable Care Act (ACA), which achieved a 70 percent reduction in outlier costs — from $1.2 billion in 2009 to $350 million in 2010 — and is on track to generate a total of $11 billion in taxpayer savings over the next decade. By capping Medicare outlier claims at 10 percent, the policy was effective in stemming what was considered to be unchecked fraud and abuse.

“CBO’s report underscores the importance of advancing policy solutions like SHHIPS that are proven to strengthen the delivery of healthcare to our nation’s seniors by protecting the Medicare program against fraudulent activity,” stated Eric Berger, CEO of the Partnership for Quality Home Healthcare. “We are committed to advancing targeted program integrity solutions, which present a more sustainable approach to reform than deep Medicare cuts or increased beneficiary costs.”

Nationwide, 3.5 million senior and disabled Americans rely on the Medicare home health benefit for clinically advanced, cost effective and patient preferred home healthcare.

“America’s seniors deserve the highest quality, most cost effective, and most secure Medicare program available, which is only possible through program integrity reforms that specifically target fraudulent behaviors,” added Berger.