American Medical News
NEWS IN BRIEF — Posted Aug. 5, 2013
New home health professionals in Miami and Chicago will be banned temporarily from enrolling in federal health programs due to years of fraud and an abundance of agencies in those areas, the Centers for Medicare & Medicaid Services announced.
The enrollment moratorium began July 30 and will last for six months. Federal officials determined that recent fraud trends had warranted the enrollment hold.
“CMS is using all available tools, including these moratoria, to combat fraud, waste and abuse in these vital health care programs,” said CMS Administrator Marilyn Tavenner. “While maintaining patients’ access to care, we are putting would-be fraudsters on notice that we will find and stop them before they can attempt to bill Medicare, Medicaid” and the Children’s Health Insurance Program.
CMS compared Miami and its surrounding counties with 25 other metropolitan areas with at least 200,000 Medicare patients. The Miami area had 37.6 home health agencies per 10,000 beneficiaries, while the other regions had 1.8. The Chicago metro region’s ratio was 7.7. CMS also found that $10,287 per home health patient was paid annually to agencies in Miami, while the rate in the other areas was $5,783.
“High outlier payments to Miami-Dade home health agencies have persisted for several years despite CMS’ efforts to limit outlier payments through policy changes,” officials stated in the notice.
CMS also placed a moratorium on enrolling ambulance suppliers in Houston and its surrounding counties. CMS data show there were 9.5 ambulance suppliers per 10,000 Medicare beneficiaries, which is 10 times higher than the average for similar metropolitan areas.