Kusserow’s Corner: CMS Moratoria Extending for New Home Health Agencies and Ambulance Services

Over the last year, I have been reporting on a large number of enforcement actions by the Department of Justice (DOJ) led Medicare Strike Force in eight target cities. A disproportionate number of cases involved home health agencies and ambulance services that many consider to be among the most vulnerable to fraud in health care. In July 2013, CMS made initial use of authority under the Affordable Care Act to use temporary enrollment moratoria to prevent fraud where they have found that fraud trends warranted a moratorium on home health providers and ambulance suppliers in certain geographic areas. This was followed in February 2014 with a second wave of enrollment moratoria on enrollment.

Now again, CMS announced a notice issued in the Federal Register that a new temporary moratoria on the enrollment of home health agencies in four metropolitan areas (Fort Lauderdale, Detroit, Dallas, and Houston). This new temporary moratoria also includes the enrollment of new ground ambulance suppliers in the Greater Philadelphia area. CMS is also extending for six months the current enrollment moratoria of home health agencies in Chicago and Miami and for Houston area ground ambulance supplier enrollments in its Medicare, Medicaid, and Children’s Health Insurance Program (CHIP) operations. This is the second wave of the agency’s use of this powerful tool to fight fraud and safeguard taxpayer dollars while ensuring patient access to care is not interrupted.

CMS also consulted with the HHS Office of Inspector General (OIG) and the DOJ, and found that fraud trends warranted a moratorium on home health providers and ambulance suppliers in these geographic areas. CMS review included key factors of potential fraud risk including a disproportionate number of providers and suppliers relative to beneficiaries, and extremely high utilization. All the geographic areas named in the moratoria ranked high in these fraud risk factors.

For more details on the employment of the moratoria by CMS, as well as the host of fraud cases that generated this decision, check the prior blogs on the subject.

Richard P. Kusserow served as DHHS Inspector General for 11 years. He currently is CEO of Strategic Management Services, LLC (SM), a firm that has assisted more than 3,000 organizations and entities with compliance related matters. The SM sister company, CRC, provides a wide range of compliance tools including sanction-screening.

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Copyright © 2014 Strategic Management Services, LLC. Published with permission.