CMS Extends Ban on New Home Health Agencies and Ambulance Suppliers

Thursday, March 6, 2014
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

The Centers for Medicare and Medicaid Services (CMS) continues to stop fraudulent repayment claims before they happen. In an effort to do so, the agency is temporarily blocking several home health agencies (HHAs) and ground ambulance suppliers in fraud hot spots around the country from enrolling in and receiving reimbursements from Medicare, Medicaid and the Children’s Health Insurance Program (CHIP) programs.

Click here to read the press release from CMS.

The six-month moratorium began January 31, 2014. The agency performed a similar enrollment moratorium in July 2013. Click here to read my previous blog.

The Patient Protection and Affordable Care Act (PPACA) allows CMS to prohibit new providers from joining the program where necessary to prevent or fight fraud. July 2013, was the first time CMS exercised its authority.


Areas Effected and Why.

CMS announced it will lengthen its temporary moratorium on new HHAs in Fort Lauderdale, Detroit, Dallas and Houston. The updated moratorium also includes the enrollment of new ground ambulance suppliers in the Greater Philadelphia area. CMS is also extending, for six-months, the current enrollment moratoria of HHAs in Miami and Chicago and for the Houston area ground ambulance supplier enrollments.

According to CMS, the decision to extend the moratorium was based on a disproportional number of providers and suppliers relative to beneficiaries, a quick increase in enrollment applications from providers and suppliers, and extremely high utilization in these areas.


Other CMS Initiatives to Fight Fraud.

Instead of continuously extending the moratorium, CMS is coming up with other ways to fight fraud. According to an article on Modern Healthcare, later this year CMS will unveil plans to have owners of newly enrolled HHAs and durable medical equipment agencies, as well as other providers it deems to be high risk, undergo fingerprint-based background checks. To pass, according to Modern Healthcare, an executive must not have been convicted in the last 10 years of a felony charge for any crime that endangers Medicare beneficiaries. If the executive fails, the executive and the company could be prohibited from participating in CMS programs. To read the entire article from Modern Healthcare, click here.


What This Means for Health Care Professionals and Providers.

The Affordable Care Act seeks to improve anti-fraud and abuse measures by focusing on prevention rather than the traditional “pay-and-chase” model of catching crooks after they have committed fraud. Click here to read a blog on the Affordable Care Act’s other fraud fighting tools.

By knowing the government is beefing up measures to fight healthcare fraud, providers can attempt to avoid practices that are likely to lead to Zone Program Integrity Contractor (ZPIC) or Medicare Administrative Contractor (MAC) audits. Additionally, a provider can be prepared for potential audits by increasing its documentation and compliance efforts.


Contact Health Law Attorneys Experienced in Home Health Agency Cases.

The Health Law Firm and its attorneys represent home health agencies and home health agency employees in a number of different matters including incorporation, preparing contracts, defending the facility against malpractice claims, licensing and regulatory matters, administrative hearings, and routine legal advice.

To contact The Health Law Firm, please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.


Comments?

What do you think about the extended moratorium? Do you think this is helping to deter healthcare fraud? Please leave any thoughtful comments below.


Sources:

Chang, Daniel. "Fed Continue Ban on New Home Health Agencies in Miami-Dade, Extend it to Broward." Miami Herald. (January 30, 2014). From: http://www.miamiherald.com/2014/01/30/3903707/feds-continue-ban-on-new-home.html

Dickson, Vicki. "CMS Blocking Some Home Health Agencies, Ambulance Suppliers from Reimbursements." Modern Healthcare. (January 30, 2014). From: http://www.modernhealthcare.com/article/20140130/NEWS/301299960

Centers for Medicare and Medicaid Services. “Second Wave of CMS’ Enrollment Moratoria Extended for Home Health and Ground Ambulance Suppliers; Four New Geographic Areas Added.” CMS.gov. (January 30, 2014). From: http://www.cms.gov/Newsroom/MediaReleaseDatabase/Press-releases/2014-Press-releases-items/2014-01-30-2.html


About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law.  He is the President and Managing Partner of The Health Law Firm, which has a national practice.  Its main office is in the Orlando, Florida, area.  www.TheHealthLawFirm.com  The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone:  (407) 331-6620.


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3/6/2014

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