Healthcare Business News

CMS blocking some home health agencies, ambulance suppliers from reimbursements

By Virgil Dickson
Posted: January 30, 2014 - 6:30 pm ET

The CMS, hoping to stop fraudulent repayment claims before they occur, is temporarily blocking several home health agencies and ground ambulance suppliers located around the country from enrolling in and receiving reimbursement from the Medicare, Medicaid and Children's Health Insurance (CHIP) programs.

The affected entities are located in Chicago, Fort Lauderdale, Fla, Miami, Detroit, Dallas, Houston and the Greater Philadelphia area. The freezes are allowed under a provision in the Patient Protection and Affordable Care Act that aims to move the CMS beyond a “pay and chase” fraud model to one that's focused on prevention, CMS Administrator Marilyn Tavenner said in a statement.

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“Today's announcement shows we are continuing our intense fight against fraud, waste and abuse in these vital healthcare programs,” Tavenner said. The agency performed a similar enrollment moratorium in July 2013.

The CMS chose to focus on these areas following consultation with HHS'Office of Inspector General and the Justice Department, which found a disproportionate number of providers and suppliers relative to beneficiaries along with extremely high utilization in these areas.

The hold is expected to last for six months starting Jan. 31. However, the CMS said it may lift the moratorium earlier or extend it another six months by issuing another notice in the Federal Register.

In another preventive measure, the CMS later this year plans to have owners of newly enrolled home healthcare and durable medical equipment agencies, as well as other providers it deems to be high risk, undergo fingerprint-based background checks.

The background checks are expected to affect as many as 7,500 executives each year, according to the CMS. If they fail, they and their companies could be prohibited from participating in CMS programs.

To pass, an executive must not have been convicted in the last 10 years of a felony charge for crimes such as murder, rape, extortion, embezzlement, tax evasion and any act that endangers Medicare beneficiaries.

Follow Virgil Dickson on Twitter: @MHvdickson

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