Community leaders applaud CMS' efforts to target fraudulent activity within Medicare program

Community leaders urge program integrity reforms and targeted solutions to combat wasteful spending

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 commended the Centers for Medicare and Medicaid Services (CMS) for extending safeguards designed to protect Medicare beneficiaries, prevent fraudulent behavior and save taxpayer dollars.

On Thursday, CMS announced new moratoria on the enrollment of home health agencies in the metropolitan areas of Fort Lauderdale, Detroit, Dallas and Houston and extended the current enrollment moratoria of home health agencies in Chicago and Miami for six months.  Data show these areas have historically been hotspots for fraud and abuse.

The Partnership strongly supports program integrity reforms as an alternative to increasing out-of-pocket costs for vulnerable beneficiaries and across-the-board cuts to Medicare.

"We applaud CMS' efforts to target the isolated instances of fraudulent activity within the Medicare program and urge the agency to advance more pro-patient solutions that prevent aberrant behaviors rather than across-the-board cuts and higher beneficiary cost burdens that threaten patient access to care," stated Eric Berger, CEO of the Partnership for Quality Home Healthcare. "Targeted program integrity solutions that protect patient access while saving taxpayer dollars are a much more sustainable approach."

The Partnership has put forth a package of targeted program integrity reforms known as the Skilled Home Health and Integrity Program Savings (SHHIPS) proposal to prevent payment of aberrant claims by strengthening claims review processes, creating payment safeguards and tightening participation standards, including temporary entry limitations to prevent excess growth.

SHHIPS is based upon a successful policy that placed a 10 percent cap on Medicare outlier claims to stem what was considered to be unchecked fraud and abuse. Adopted by CMS and included in the Affordable Care Act (ACA), this single reform achieved a 70 percent reduction in outlier costs — from $1.2 billion in 2009 to $350 million in 2010 — and is on track to generate a total of $11 billion in taxpayer savings over the next decade.

The Partnership is also a member of Fight Fraud First! - a coalition of seniors, persons with disabilities, military veterans and family members to advocate for the elimination of waste, fraud and abuse in Medicare and Medicaid.