Home Health & Hospice

CMS imposes first Affordable Care Act enrollment moratoria to combat fraud

Homecare Insider, August 5, 2013

The Centers for Medicare & Medicaid Services (CMS) recently announced a six-month moratoria on the enrollment of new home health provider and ambulance supplier enrollments in Medicare, Medicaid and the Children’s Health Insurance Program (CHIP) in Miami, Chicago, and Houston metropolitan areas. In a press release, CMS states that “the goal of the temporary moratoria is to fight fraud and safeguard taxpayer dollars, while ensuring patient access to care.” This is the first time CMS is exercising the authority to impose such moratoria since this authority was included in the Affordable Care Act.

Under the moratoria, existing providers and suppliers can continue to deliver and bill for services, but no new provider and supplier applications will be approved in these areas for all three programs. The temporary enrollment moratoria apply to newly enrolling:

  • Home health agencies in the Miami and Chicago metropolitan area
  • Ground ambulance suppliers in the Houston metropolitan area

The affected counties in each of the three metropolitan areas are as follows:

  • Miami: Miami-Dade and Monroe
  • Chicago: Cook, DuPage, Kane, Lake, McHenry, and Will
  • Houston: Brazoria, Chambers, Fort Bend, Galveston, Harris, Liberty, Montgomery, and Waller

According to CMS, the agency has carefully examined Medicare beneficiary access to home health and ambulance services in the affected areas, and concluded that the moratoria will not impact access to care. The Health and Human Services Office of Inspector General, the Department of Justice, and CMS reported that fraud trends in these regions warranted a moratorium on home health providers and ambulance suppliers.CMS will monitor the impact of the moratoria, including the risk of fraud schemes moving to different services or geographic areas.

To read the complete press release, click here.

To read the announcement in the Federal Register, click here.

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