The idea of thwarting fraudulent claims for Medicare home health by imposing a “targeted” moratorium on certification of new agencies now has the backing of House Democrats and Republicans.   
 
In a letter to HHS Secretary Kathleen Sebelius, Reps Jim McGovern, D-Mass., Walter B. Jones, R-N.C., and 14 House co-signers note the aging of the population has contributed to an increase in the number of home health care agencies. As a result, there also are more providers “who have a much greater interest in exploiting the Medicare program than in providing quality patient care.” Previously, the HHS Office of Inspector General recommended a similar moratorium and CMS said it was exploring the idea.
 
The letter cites the Dallas case earlier this year involving $375 million in fraudulent claims – the large majority of them for home health care of ineligible beneficiaries – that led to suspension of Medicare payments to 78 agencies. Current anti-fraud efforts, including the $208 million saved through pre-payment edits, have been helpful, but a moratorium focused on areas with above-average increases in the number of agencies would allow CMS “to review and, if necessary, modify” the home health conditions of participation or accreditation standards.
 
The lawmakers also want federal officials to refer to data from the Medicare Payment Advisory Commission, which “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.”