Deadline for Congress to Sign Moratorium Letter for Home Care

Reps. Jim McGovern (D-MA) and Walter Jones (R-NC) are circulating a “Dear Colleague” letter inviting members of the House of Representatives to sign a letter urging the Centers for Medicare and Medicaid Services (CMS) to use its authority to put a temporary and targeted moratorium on new home health agencies to prevent waste, fraud and abuse. The deadline for members of the House of Representatives to sign on to the letter is Tuesday, November 20, 2012. Currently, Reps. Deutch (D-FL), Farr (D-CA), Lewis (D-GA), Olver (D-MA) and Welch (D-VT) have agreed to sign the letter.

The National Association for Home Care & Hospice (NAHC) has supported the use of temporary, targeted new provider moratoria as a way to address concerns about fraud, waste, and abuse and commends Reps. McGovern and Jones for their efforts. NAHC included the implementation of CMS’ moratorium authority in its list of recommendations to the Senate Finance Committee on how to address waste, fraud and abuse.

NAHC is encouraging home care advocates to call their representative’s office and ask that their member of Congress sign on to this letter. To find out the name of your representative and obtain contact information, click here. Advocates may forward the “Dear Colleague” and sign on letter if their representative’s office has not seen them yet.

Listed below is a sample letter from the Ohio Council of Home Care and Hospice:

Dear Colleague,

As thousands of Baby Boomers become eligible for Medicare every day, the demand for
affordable high-quality home health care continues to grow. Unfortunately, a few unscrupulous home health agencies have taken advantage of the rising demand by engaging in inappropriate and questionable billing practices for their own personal gain.

In August, the Office of the Inspector General at HHS published a study titled “Inappropriate and Questionable Billing by Medicare Home Health Agencies” that found that, among other things, that home health agencies with questionable billing practices were concentrated in just a few states. In these states, the number of home health agencies has exploded rapidly in the past few years.

We are pleased to see that HHS has taken serious steps to root out fraud and enforce
stiffer penalties for agencies that engage in fraudulent behavior. We also believe that now is the time to focus on prevention in addition to enforcement. That is why we are asking CMS to put in place a temporary, targeted moratorium on the establishment of new home health agencies until it puts in place better controls to prevent waste, fraud and abuse. We believe that a moratorium will prevent individuals from establishing sham home health agencies just for their own financial gain and give HHS a chance to better address current issues of waste, fraud and abuse.

To join us in signing onto the letter below, please contact Jennifer Walters (McGovern) at
Jennifer.walters@mail.house.gov or Brad Ryon (Jones) at bradley.ryon@mail.house.gov.

Sincerely,
James P. McGovern Walter B. Jones
Member of Congress Member of Congress

 

The Honorable Kathleen Sebelius
Secretary of the US Department of Health & Human Services
The U.S. Department of Health and Human Services
200 Independence Avenue, SW
Washington, D.C. 20201

Dear Secretary Sebelius:
With a rapidly aging population and a need to control costs, our country, now more than ever,
has a demand for quality home health care services. There is, however, growing evidence of a
rapid escalation in the home care marketplace, raising the prospect of providers who have a
much greater interest in exploiting the Medicare program than in providing quality patient care.

A recent case of Medicare fraud, where a $375 million scheme was uncovered, multiple arrests
were made and payment was suspended to 78 home health agencies, was only the latest example. As a result of the fraudulent activity of a few, the home health community at large is seeing their reputation assaulted and their agencies subject to increasing regulatory burdens and payment reductions.

We applaud your leadership in bringing a renewed energy to anti-fraud task forces and
enforcement, through the establishment of HEAT (Health Care Fraud Prevention and
Enforcement Action Team) and the introduction of stiffer penalties for offenders. We also
believe it is time that a focus equal to that now placed on enforcement is placed on prevention.

Current efforts, such as pre-payment claims edits that have saved HHS $208 million, are a good start, but not enough. We respectfully, ask that you direct the Centers for Medicare and Medicaid Services (CMS) to use its authority to put a temporary and targeted moratorium on new home health agencies until better controls to prevent waste, fraud and abuse can be put in place. Both through the analysis of MEDPAC and CMS regional and state specific data, it is possible to identify areas to target, ideally where growth in numbers of agencies and utilization of the Medicare benefit has exceeded a certain baseline of growth or a ratio of population to the number of agencies. Putting in place such a temporary, targeted moratorium would provide HHS and CMS time to revisit and revise either the current home health Conditions of Participation or the “deemed” accrediting practices to put in place more rigorous upfront accounting for fiscal stability and program quality standards compliance. A targeted moratorium will send a strong signal that the Medicare program is serious about preventative and anti-fraud measures.

Although it is not the driving factor in calling for a moratorium, it should be noted that the cost savings potential of a moratorium is not insignificant. Data from MEDPAC and others indicate that oversupplied areas tend to push per capita utilization of the home health benefit beyond any reasonable expectation, even considering a region’s demographics. We owe it to both the taxpayers and Medicare beneficiaries to see that they receive only quality, necessary home health services.

Your attention to this matter is very much appreciated and we hope you will seriously consider
action on this issue.

 

From the NAHC Report Article