Home Health & Hospice Week

All agencies can expect increased medical review and more hoops to jump through. Home health agencies are relieved Medicare is finally taking action against rampant fraud in the industry, but legitimate providers are likely to get caught in the crossfire. The Centers for Medicare & Medicaid Services has announced "aggressive new steps" to find and stamp out fraud in Medicare, with particular attention to home health agencies and durable medical equipment suppliers. The initiative includes increased medical review and unannounced site visits of HHAs and suppliers. Zero in: CMS is taking a special interest in Miami-Dade county in Florida. The agency has suspended payments for the top 10 agencies of outlier billing, according to press reports. The feds took such action due to the extraordinary statistics for the county. Reimbursement for Miami HHAs is on track to reach $1.3 billion this year -- a 1,300 percent increase over the last five years and 20 times the national average. In contrast, the beneficiary population has risen only about 10 percent in that time, reports USA Today. And the main problem is billing of outlier patients. These patients are usually receiving daily visits for insulin injections. The top 10 agencies that received suspension derive between 65 and 80 percent of their Medicare revenues from outlier pa-tients, reports The Miami Herald. In Miami, outlier payments account for 60 percent of the HHA total. That's compared to 6 percent in the rest of the nation. And so far this year, Miami-Dade's home health spending is six times larger than that for Los Angeles County, Calif. That's despite the fact that L.A. has a beneficiary population three times larger than Miami's. Reaction: "I'm amazed that it has taken this long, but I'm relieved that CMS now reports that they have gotten into gear," says Bob Wardwell with the Visiting Nurse Associations of America. "If CMS is able to successfully target the abusers and leave the compliant folks alone, I know our VNAs will welcome it with open arms," says Wardwell, a former CMS official. HHA Medicare fraud has been allowed to go unchecked and this sort of crackdown is sorely needed, says Gene Tischer with trade group Associated Home Health Industries of Florida. "I'm just thrilled," Tischer tells Eli. The National Association for Home Care & Hospice "is pleased that the Medicare program is finally taking action, since the home care industry notified CMS several years ago about fraudulent outlier billing," NAHC points out. Bystanders harmed: While agencies are eager to see fraudulent providers called onto the carpet, they are likely to see "collateral damage" from the crackdown efforts, Wardwell warns. "There is sad precedent in the past for CMS and [the HHS Office of [...]