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Home Health & Hospice Week

Fraud & Abuse:

FEDS TURN UP THE ENFORCEMENT HEAT ON HOME CARE PROVIDERS

Published on Tue May 26, 2009

Will legitimate providers get caught in the crossfire?

You've got your eye on the RACs, the ZPICs, the OIG, and Medicare auditors, but now CMS is taking its oversight up a notch with a new interagency strike force.

The Centers for Medicare & Medicaid Services and the Department of Justice have launched the Health Care Fraud Prevention and Enforcement Action Team (HEAT) to combat fraud in the Medicare program, with a special focus on home health agencies and durable medical equipment suppliers.

CMS will expand its strike force team operation to target fraud locally in Detroit and Houston. The strike force already operates in South Florida and Los Angeles. The strike force teams will eventually spread to 10 other cities not yet named, the Associated Press reports.

Home care providers in Detroit and Houston should expect more of the tough actions their colleagues in South Florida and L.A. have seen. The strike forces there have collected $186 million and $55 million, respectively, in criminal fines and civil recoveries, HHS says.

"We know these strike forces work," says Attorney General Eric Holder in a statement.

HHA impact: Like in South Florida, HHAs in Detroit and Houston will see electronic monitoring of their claims for red flags. Florida agencies have seen payment suspensions and legal action.

Supplier impact: DME suppliers will see increased site visits to suppliers applying for Medicare enrollment, HHS says. The visits will aim to "prevent impostors from posing as legitimate DME providers."

"With this announcement, we raise the stakes on health care fraud by launching a new effort with increased tools, resources, and a sustained focus by senior-level leadership," Holder says."Every year we lose tens of billions of dollars in Medicare and Medicaid funds to fraud."

"Most providers are doing the right thing and providing care with integrity," acknowledges Health and Human Services Secretary KathleenSebelius in the release. "But we cannot and will not allow billions of dollars to be stolen from Medicare and Medicaid through fraud, waste and serious abuse of the system."

The HEAT team will be comprised of senior officials from DOJ and HHS.

The joint task force is also appealing to Medicare beneficiaries themselves to report fraud with a newWeb site called "StopMedicare Fraud" at www.hhs.gov/stopmedicarefraud.

Show HHS TheMoney

The new initiative from the Obama administration gets a jump on the President's proposed increase in fraud-fighting activity in his 2010 budget (see Eli's HCW, Vol. XVIII, No. 18, p. 138).

"The anti-fraud efforts in the President's budget could save $2.7 billion over five years by improving oversight and stopping fraud in the Medicare and Medicaid programs," HHS notes.

Dollar signs: "There is an incredible amount of money that can be recovered and returned to the health care trust fund," Tony West, head of DOJ's Civil Division, told the Washington Post.

Every dollar invested in fraud enforcement returns at least $1.55, Sebelius told the press.

The American Association for Homecare,which has been touting its own 13-step anti-fraud plan as an alternative to competitive bidding and other DME rate cuts, is behind the new campaign. But the trade group urges CMS to adopt the even tougher anti-fraud steps in its plan.

"For a long time, the activities of criminals have tarnished the good name of honest providers of home medical equipment and services," AAHomecare's Tyler Wilson says in a release. "We support expanded and more effective government efforts to stamp out fraud."

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