The administrator of the Centers for Medicare and
Medicaid Services said the agency is targeting providers of home health
care in eight counties in the Miami and Chicago areas.
For the first time in history, federal health officials
said Friday they will ban certain types of Medicare and Medicaid
providers in three high-fraud cities, including Miami, from enrolling in
the taxpayer-funded programs for the poor as part of an effort to
prevent scams.
The strict moratoriums, which start
Tuesday, give federal health officials unprecedented power to choose any
region and industry with high fraud activity and ban new Medicare and
Medicaid providers from joining the programs for six months.
They
wouldn't ban existing providers.
The administrator of the Centers for
Medicare and Medicaid Services said the agency is targeting providers of
home health care in eight counties in the Miami and Chicago areas. All
ambulance providers would be banned in eight counties in the Houston
area.
The moratorium, which was first
reported by The Associated Press, will also extend to Children's Health
Insurance Program providers in the same areas, agency administrator
Marilyn Tavenner said in a statement.
It's unclear how many providers will be shut out of the programs.
There were 662 home health agencies
in Miami-Dade in 2012 and the ratio of home health agencies to Medicare
beneficiaries was 1,960 percent greater in Miami Dade County than other
counties, according to figures from federal health officials.
South Florida, long known as
ground-zero for Medicare fraud, has also had several high profile
prosecutions involving that industry.
In February, the owners and operators
of two Miami home health agencies were sentenced for their
participation in a $48 million Medicare fraud scheme.
The number of home health providers
in Cook County, Ill., increased from 301 to 509 between 2008 and 2012.
There were 275 ambulance suppliers in Harris County, Texas, in 2012. The
ratio of providers to patients in both regions was also several hundred
times greater than in other counties, federal health officials said.
Top Senate Republicans have
criticized the agency for not using the powerful moratoriums sooner as a
tool to combat an estimated $60 billion a year in Medicare fraud.
Senators Chuck Grassley, who is the ranking Republican on the Judiciary
Committee, and Orrin Hatch, who is the ranking Republican on the Finance
Committee, sent a letter to federal health officials in 2011 urging
them to use the bans.
"While it's certainly better late
than never, it's unfortunate that it took CMS three years to use the
tools it's had to protect seniors," Hatch said in a statement Friday,
adding he hoped "to see more action like this."
Officials for the Department of
Health and Services inspector general lobbied hard to ensure moratorium
power was included under the Affordable Care Act as the Obama
administration focuses on cleaning up fraud on the front end by
preventing crooks from getting into the program in the first place.
"There's no shortage of bad actors
to defraud the taxpayers, and the number gets bigger all the time, so
it's good to see the administration at last using this new tool to fight
fraud," Grassley said in a statement.
In the past, federal health
officials tried to stall new provider applications from being processed,
hoping to slow the number flocking to high-fraud sectors. But when
providers inevitably complained, the agency had to process their
paperwork.
The federal agency can also revoke
the IDs of suspicious providers, but those are temporary and many
companies are able to reenroll later or enroll under a different name.
Federal health officials have been
reluctant to use one of its most powerful new tools, worrying
moratoriums may harm legitimate providers and hamper patients' access to
care. Tavenner said in the statement that would not happen, but the
agency didn't elaborate.
Agency officials said they intend to consider
other moratoriums in different industries in other cities going forward.
The ability to target certain
industries and cities is especially helpful as Medicare fraud has
morphed into complex schemes over the years, moving from medical
equipment and HIV infusion fraud to ambulance scams, as crooks try to
stay one step ahead of authorities.
Fraudsters have also spread out
across the country, bringing their scams to new cities once authorities
catch onto them.
The scams have also grown more
sophisticated, using recruiters who are paid kickbacks for finding
patients, while doctors, nurses and company owners coordinate to appear
to deliver medical services that they are not.
The moratoriums come as budget cuts
are forcing federal health officials to retract its watchdog arm as it
launches its largest health care expansion since the Medicare program.
Health and Human Services inspector
general officials said they are in the process of cutting 20 percent of
its staff, from 1,800 at its peak to 1,400, and cancelling several high
profile projects, including an audit that would have investigated
technology security in the federal and state health exchanges launching
in October.
The project was slated to examine issue including whether
patient information was secure from hackers on the online marketplace,
where individuals and small businesses can shop for health insurance.
SOURCE:http://www.nbcmiami.com
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