Home Health & Hospice Week

More medical review, audits, and enforcement are in the 2024 budget proposal.

If the current level of oversight has you sweating, get ready for more pressure next year.

“Current HCFAC funding levels to combat fraud, waste, and abuse are helping to safeguard Federal Health programs, but more could be done to ensure the government is keeping pace with the size, scope, and complexity of the healthcare industry and federal programs,” the Department of Health and Human Services says in its Budget in Brief document that summarizes President Biden’s fiscal year 2024 budget proposal released March 9.

“The budget includes significant new investment in both the mandatory and discretionary HCFAC accounts totaling $5.2 billion over ten years,” HHS details. “The investment will more than pay for itself based on years of documented recoveries to the Medicare Trust Funds and federal Treasury,” HHS maintains.

“The budget grows all but one mandatory HCFAC funding stream by 20 percent over current law baseline levels,” HHS explains. “The additional mandatory HCFAC investment will support top priorities such as Medicare fee-for-service medical review; addressing emerging fraud schemes; fraud and abuse audits and investigations; increased staffing for oversight and enforcement; cutting-edge data analytics to detect trends and outliers; and fraud and abuse law enforcement and prosecution activities,” the brief lists.

“This additional investment is projected to total $3.8 billion over the 10-year budget window and yield $5.4 billion in net savings over 10 years,” HHS says. “Medicare program integrity efforts yield a robust rate of return to the Trust Funds of over $8 for every $1 spent based on a 3-year rolling average and consistently generate savings of over $10 billion annually,” the agency adds.

In an 81-page Justification of Estimates budget document, the HHS Office of Inspector General gives an example of how it has generated savings in the home health arena.

“Using data analytics, OIG identified four geographic hotspots — Florida, Texas, and select areas in Southern California and the Midwest — that have large numbers of home health care providers with characteristics that OIG determined are commonly associated with suspected fraud or abuse, such as billing Medicare for significantly higher amounts and/or with greater frequency,” the watchdog agency explains. “OIG focused on reducing inappropriate Medicare spending to home health care providers in these geographic hotspots.”

The result: “OIG investigations, audits, evaluations, and other efforts contributed to an overall 20-percent decrease in Medicare home health care payments in the four geographic hotspots between the baseline year of CY 2015 and CY 2020,” the report touts. “Nationally, the decrease in home health care spending over this same period was 11 percent. With the sizeable reduction in home health care expenditures, several of these hotspot spending levels are much closer to national expenditure levels.”

The OIG also boasts that “in the Consolidated Appropriations Act of 2021, Congress adopted OIG recommendations to establish new remedies for poorly performing hospices and require public disclosure of hospices’ deficiencies.”

And the agency assures thanks to its efforts, “people who depend on HHS programs are protected from grievous harms, such as elder abuse” and ”substandard” and hospice care.

Note: The OIG Justifications document is at https://oig.hhs. gov/documents/budget/1105/FY-2024-HHS-OIG-CJ.pdf.