New GAO Report Reaffirms Need for Reforms to Prevent Medicare Fraud and Abuse

WASHINGTON, DC — Leaders in the home healthcare community today called for targeted Medicare reforms to combat fraud and abuse in response the U.S. Government Accountability Office (GAO) report on healthcare fraud, “Types of Providers Involved in Medicare, Medicaid, and the Children’s Health Insurance Program Cases.”

The Partnership for Quality Home Healthcare — a national coalition representing more than 1,500 community- and hospital-based home health agencies nationwide — strongly supports program integrity reforms to target and prevent fraud and abuse. Data analyses from the Medicare Payment Advisory Commission (MedPAC) demonstrate that Medicare fraud in home health is largely isolated in a few select areas of the country, suggesting that targeted reforms can successfully identify — and eliminate — fraudulent activity from the Medicare program.

The Partnership has been working with lawmakers and community leaders for more than a year to develop proposals for targeting fraud and abuse and strengthening 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 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.

Provisions of the home healthcare community’s package draw from a 2009 proposal that capped Medicare outlier claims at 10 percent to curb fraudulent billing practices. The proposal, which was adopted as part of the Affordable Care Act (ACA), achieved an estimated savings of $853 million in 2010 alone and an estimated $11 billion over 10 years. The successful policy, which prevents payment for aberrant claims before they occur, underscores the need to reform Medicare’s current “pay and chase” practices.

“This week’s GAO report is a stark reminder that fraudulent activity must be targeted, identified and stopped,” said Senator John Breaux, senior counsel to the Partnership. “As the debate over fiscal savings continues, policies that save money while targeting fraud, protecting seniors and strengthening the Medicare program are the solutions lawmakers should advance before turning to arbitrary Medicare cuts or burdensome fees on seniors.”

Skilled home healthcare is clinically advanced, cost-effective and patient preferred. Nationwide, 3.5 million Medicare beneficiaries receive skilled home healthcare services to treat illnesses related to acute, chronic or rehabilitative needs.

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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 community- and hospital-based home healthcare agencies nationwide, the Partnership is dedicated to developing innovative reforms to improve the program integrity, quality, and efficiency of home healthcare for our nation’s seniors. To learn more, visit www.homehealth4america.org. To join the home health policy conversation, connect with us on Facebook, Twitter and our blog.