Home Health & Hospice Week

CMS allows "rampant criminality" in Medicare, district attorney in Texas says.

The repercussions of Medicare fraud cases covered in the mainstream press are snowballing.

Rep. Charles Boustany (R-La.), a physician, has sent letters to Department of Health and Human Services Secretary Kathleen Sebelius, U.S. Attorney General Eric Holder, and Centers for Medicare & Medicaid Services Acting Admini-strator Marilyn Tavenner, requesting they provide statistics on their fraud-fighting activities in Texas. Boustany, chair of the Ways and Means Subcom-mittee on Oversight, wants details about "outlier providers" who have "unusual billing patterns," the letters say.

In the letters, Boustany suggests HHS, OIG and CMS are not cracking down on these outlier billers like they should be. After a March 2011 subcommittee hearing on the problem, "recent reports out of Texas suggest outlier providers continue to operate with impunity," Boustany criticizes. The letter lists high Medicare payment levels to Houston-area home health agencies as one outlier problem, as well as charges of kickbacks.

The home health industry, which has been rocked by high-profile fraud busts and operations, has been quick to support Boustany's efforts. "Analyses of Medicare data show that targeting the small number of providers who bill outside national norms would significantly reduce annual Medi-care spending," says lobbying group Partnership for Quality Home Healthcare. The group calls for "firm limits on episode and low-utilization payments in order to prevent fraudulent activity before it takes place."

Example: The 10 percent cap on outliers has already saved Medicare nearly $1 billion in 2010 alone, points out PQHH counsel and former House Energy and Commerce Committee chairman Billy Tauzin. The industry proposed that measure, Tauzin notes in a release.

"I am delighted," Harris County District Attorney Pat Lykos told the Houston Chronicle about Boustany's letters. "We have been trying since 2009 to get the attention of federal authorities and most especially CMS, and they didn't even give me the courtesy of responding," Lykos told the newspaper. "We're talking about millions of dollars, and it's unconscionable. They're stealing from people truly in need, robbing the taxpayers, and it's rampant criminality."

Resource: For free copies of the letters, e-mail editor Rebecca Johnson at rebeccaj@eliresearch.com with "Boustany letters" in the subject line.