New IOM Report Underscores Need for Program Integrity Reforms to Strengthen Medicare for Nation’s Seniors

Washington, DC — The Institute of Medicine (IOM) has released a report, which attributes geographic variations in healthcare spending in home health to the isolated nature of Medicare fraud and abuse. In response, the Partnership for Quality Home Healthcare — a coalition of home health providers dedicated to developing innovative reforms to improve the program integrity, quality, and efficiency of home healthcare for our nation’s seniors — today reiterated its support for program integrity reforms as a preferable alternative to across-the-board Medicare cuts and the re-imposition of burdensome out-of-pocket costs for home health beneficiaries. The IOM report states, “the literature suggests that large deviations from the national average in [home health] spending and utilization in some areas may be an indication of fraud.” The report goes on to identify specific geographic areas across the country that are recognized as high-risk for Medicare fraud, which is consistent with Partnership analyses of Medicare claims data finding nearly 90 percent of all aberrant Medicare home health spending is occurring in a small number of counties in just a few states. ”We commend the IOM panel for recognizing the impact the isolated nature of home health fraud has on healthcare spending and encourage lawmakers to consider pro-patient solutions including program integrity reforms that can achieve savings without unfairly threatening vulnerable beneficiaries and compliant providers with across-the-board funding cuts and increased beneficiary costs,” said Eric Berger, CEO of the Partnership. Data show fraudulent and abusive billing practices in the home health sector are confined to a small number of isolated geographic areas of the country. The Medicare Payment Advisory Commission (MedPAC) has identified 25 counties (of the nation’s 3,143 counties) where the highest levels of Medicare billing and suspected abuse are occurring, indicating that Medicare data allows the government to identify and target fraudulent acts. Based on this data, the Partnership is urging lawmakers to consider program integrity reforms instead of re-imposing home health copayments on seniors (which Congress repealed in 1972) or enacting additional cuts to Medicare funding. The Partnership has put forth the Skilled Home Health and Integrity Program Savings (SHHIPS) proposal to prevent payment of aberrant claims by tightening participation standards, strengthening claims review processes, and creating payment safeguards. Home healthcare is widely recognized as patient preferred, clinically advanced and cost-effective, and is utilized by 3.5 million Medicare beneficiaries nationwide.