Florida congressman joins call for moratorium
In light of ongoing reports of Medicare home health care fraud across the nation – including yesterday’s news that indictments were filed in Miami in a fraud case totaling more than $200 million in fraudulent claims – members of the U.S. House of Representatives are sending a letter to the U.S. Department of Health and Human Services calling for a targeted, temporary moratorium on new Medicare provider numbers “until better controls to prevent waste, fraud and abuse can be put in place.”
The letter does not specify what targeted areas would be subject to the moratorium, but Miami-Dade County is expected to be part of the discussion considering Medicare home health claims far exceed the national average.
The letter is spearheaded by U.S. Reps. James McGovern (D-MA) and Walter Jones (R-NC), indicating this is a bipartisan effort to crackdown on what is perceived as rampant Medicare fraud in targeted areas of the nation. The congressmen are calling on colleagues in Congress to cosign the letter, which is expected to be sent to HHS Secretary Kathleen Sebelius later this month.
HCAF, with The National Association for Home Care & Hospice and affiliated state home care associations, supports a temporary, targeted moratorium. The Patient Protection and Affordable Care Act, President Obama’s signature legislative achievement, gave HHS the authority to impose moratoriums in targeted areas with aberrant fraud, abuse and waste.
Yesterday, Congressman Ted Deutch (D-Boca Raton) became Florida’s first member of Congress to cosign the letter to Secretary Sebelius. HCAF appreciates Congressman Deutch’s leadership on this critical issue and is calling on the 24 other members of the congressional delegation to follow his lead and show their support for this initiative.
The full text of the letter to Secretary Sebelius is below:
Dear Secretary Sebelius,
With a rapidly aging population and a need to control costs, our country, now more than ever, has a demand for quality home health care services. There is, however, growing evidence of a rapid escalation in the home care marketplace, raising the prospect of providers who have a much greater interest in exploiting the Medicare program than in providing quality patient care.
A recent case of Medicare fraud, where a $375 million scheme was uncovered, multiple arrests were made and payment was suspended to 78 home health agencies, was only the latest example.
As a result of the fraudulent activity of a few, the home health community at large is seeing their reputation assaulted and their agencies subject to increasing regulatory burdens and payment reductions.
We applaud your leadership in bringing a renewed energy to anti-fraud task forces and enforcement, through the establishment of HEAT (Health Care Fraud Prevention and Enforcement Action Team) and the introduction of stiffer penalties for offenders. We also believe it is time that a focus equal to that now placed on enforcement is placed on prevention. Current efforts, such as pre-payment claims edits that have saved HHS $208 million, are a good start, but not enough. We respectfully, ask that you direct the Centers for Medicare and Medicaid Services (CMS) to use its authority to put a temporary and targeted moratorium on new home health agencies until better controls to prevent waste, fraud and abuse can be put in place.
Both through the analysis of MEDPAC and CMS regional and state specific data, it is possible to identify areas to target, ideally where growth in numbers of agencies and utilization of the Medicare benefit has exceeded a certain baseline of growth or a ratio of population to the number of agencies. Putting in place such a temporary, targeted moratorium would provide HHS and CMS time to revisit and revise either the current home health Conditions of Participation or the “deemed” accrediting practices to put in place more rigorous upfront accounting for fiscal stability and program quality standards compliance. A targeted moratorium will send a strong signal that the Medicare program is serious about preventative and anti-fraud measures.
Although it is not the driving factor in calling for a moratorium, it should be noted that the cost savings potential of a moratorium is not insignificant. Data from MEDPAC and others indicate that oversupplied areas tend to push per capita utilization of the home health benefit beyond any reasonable expectation, even considering a region’s demographics. We owe it to both the taxpayers and Medicare beneficiaries to see that they receive only quality, necessary home health services.
Your attention to this matter is very much appreciated and we hope you will seriously consider action on this issue.