Partnership Commends the Senate Finance Committee for its Continuing Efforts on Program Integrity Reform

WASHINGTON — Members of the home healthcare community today commended a newly released report from Senate Finance Committee members, which presents recommendations for combatting fraud, abuse and waste in the Medicare and Medicaid programs collected from 160 stakeholder organizations including the Partnership for Quality Home Healthcare.

The Partnership, a national coalition representing more than 1,500 skilled home healthcare agencies nationwide, submitted a letter to the U.S. Senate Finance Committee in June 2012, which details Medicare reforms to prevent fraud and abuse; ensure accuracy, efficiency and value; and improve quality and patient outcomes. As an organization dedicated to developing innovative reforms that will secure beneficiary access to skilled home healthcare services, the Partnership was pleased to present their recommendations and will continue to work with lawmakers in Congress to advance reforms in the 113th Congress.

“We applaud this bipartisan group of lawmakers for elevating program integrity and greatly appreciate the opportunity to take part in the process. Since its inception, the Partnership has been committed to advancing reforms to prevent the isolated instances of fraud and abuse before they can start, and we look forward to working with the Administration and Congress to see these reforms through,” said Chairman Billy Tauzin, senior counsel to the Partnership. “By working together we can strengthen the Medicare and Medicaid programs to protect beneficiaries, cost-effective providers and taxpayers alike.”

The home healthcare community has been working together for more than a year to develop a reform proposal — called the “Skilled Home Healthcare Integrity and Program Savings” (SHHIPS) Act — which would prevent payment of aberrant claims before they are made and by strengthening claims review processes and conditions of participation standards. Among the reforms submitted by the Partnership highlighted in the Senators’ compilation are:

“¢ Strengthening Medicare payment policies to prevent payment of aberrant claims;
“¢ Ensuring that provider enrollment policies are consistent and utilized effectively; and
“¢ Implementing common-sense moratorium, compliance and competency policies.

The SHHIPS proposal is based on evidence that fraud and abuse in the home health sector is extremely isolated. Analysis of MedPAC data show that abusive billing practices occur primarily in 25 counties where excessive Medicare utilization is taking place. Further, data show that nearly 90 percent of all improper payments for home healthcare services are occurring in a small number of counties in just five states. As a result, the home healthcare community believes policy makers should undertake action to address fraud and abuse in a targeted manner.

When submitting their recommendations to the Senate Finance Committee, the Partnership stated, “We urge Congress to enact a set of targeted solutions to attack this targeted problem, while safeguarding patients and the communities that honest providers serve.”

Skilled home healthcare is clinically advanced, cost-effective and patient preferred. Research shows that nearly 90 percent of American seniors prefer to age in place, stay home and remain independent. Nationwide, approximately 3.5 million Medicare beneficiaries receive skilled home healthcare services to treat illnesses related to acute, chronic or rehabilitative needs.