OIG Pressures CMS on Home Health Sanctions

As the number of home health agencies and fraud cases related to home health agencies continues to skyrocket, the Office of Inspector General (OIG) is exerting more pressure on the Centers for Medicare & Medicaid Services (CMS) to fulfill an obligation that is 15 years old.

Back in 1987, the Omnibus Budget Reconciliation Act (OBRA) directed CMS to implement intermediate sanctions for noncompliant home health agencies (HHAs). OBRA specified that the intermediate sanctions CMS created should include civil money penalties, payment suspension and appointment of temporary management. While there is a corrective process for noncompliant HHAs, the only HHA sanction option CMS currently has at its disposal is termination, an option it doesn’t use often.

Even though the number of Medicare-certified HHAs has seen a 59 percent increase between 2002 and 2009, CMS still has not issued a final rule for intermediate sanctions. It did issue a Notice of Proposed Rulemaking in 1991 but later withdrew it.

In 2008, OIG issued a report about HHAs with repeat deficiency citations and the lack of intermediate sanctions. OIG recommended that CMS follow OBRA’s 1987 directive to implement intermediate sanctions. CMS agreed with OIG’s recommendations but as of the spring of 2012, had yet to issue a proposed rule on intermediate sanctions.

Last March, OIG again pressed CMS on implementing the intermediate sanctions. In a letter to Marilyn Tavenner, CMS’ acting administrator, OIG reminded CMS of its legal obligations and that OIG had already prodded the agency on this issue in 2008.

“Although CMS indicated activities toward promulgating regulations to implement HHA intermediate sanctions, it has not yet issued a proposed rule,” OIG’s letter to Tavenner said. “Given the length of time since the passage of the original statute, CMS should make HHA intermediate sanctions a high priority and should complete their implementation as soon as possible.”

Source: The Remington Report

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