Fighting home health and ambulance fraud by putting providers on a map

CMS released public data sets and a mapping tool regarding the availability and use of Medicare services provided by ground ambulance suppliers and home health agencies. The data release is intended to improve care delivery through transparency and information sharing. CMS is using the data to identify areas where services are saturated and where there are high risks of fraud and abuse.

Data

On February 2, 2016, CMS announced a six-month extension of the temporary enrollment moratoria on new ground ambulance suppliers and home health agencies sub-units and branch locations in Medicare, Medicaid, and the Children’s Health Insurance Programs (CHIP) in seven geographic areas (see Some new providers still unable to enroll in high-risk fraud areas, Health Law Daily, February 1, 2016). Together with the data and mapping tool, CMS believes it can use the moratoria to fight fraud and safeguard the federal healthcare programs.

Fraud

Home health providers see the data release as a signal from CMS that it plans to step up its home health fraud fighting efforts. Along with the data release, CMS announced plans to use the data to pinpoint high-risk providers for increased site visits. CMS also plans to engage in monthly monitoring of home health enrollment data in order to identify and deactivate providers that do not meet Medicare requirements.

Data tools

The Moratoria Provider Services and Utilization Data Tool includes interactive maps and a dataset to identify geographic areas that might undergo consideration for a new moratorium on provider and supplier enrollments. The data includes the number of providers in a given geographic area and identifies the number of beneficiaries that use a specific health service in a particular region. The interactive maps allow for comparisons between these regions. The tool was developed from ground ambulance and home health agency paid claims data covering October 1, 2014 through September 30, 2015. The data will be updated quarterly.