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The U.S. Centers for Medicare & Medicaid Services’ (CMS) temporary moratoria on hospice and home health provider enrollment in Medicare has been working, according to Kimberly Brandt, the agency’s deputy administrator and COO.
To date, during the six-month enrollment freeze, CMS has denied 50 hospice and 250 home health applications. Also, CMS has seen “huge drops” in billing, particularly in geographic areas known to be rife with fraud. This includes states like California, Texas, Nevada, Ohio, Georgia and Arizona.
The decision to implement the moratoria took longer than a year to make at CMS, Brandt said at the National Alliance for Care at Home Annual Conference.
“We’re going through the bad actors. We’re not going after people like you,” Brandt told the crowd of hospice providers. “We want to go after the people who are defrauding the program, and that’s why we did the moratorium.”
The six-month hospice and home health moratoria are set to expire Nov. 13. The national moratoria prohibit applications for new Medicare enrollment, and they apply to certain changes in majority ownership for hospices and home health agencies.
CMS must now decide whether it will allow the moratoria to end as scheduled or if an extension is warranted. The agency by law can only extend such actions in six-month intervals. So, CMS can’t create a two- or three-month moratoria, for example.
Despite CMS’ intentions, some legitimate providers are being caught in the dragnet, particularly when it comes to payment suspensions. To date, CMS has suspended payments for 899 hospice and home health providers, with 812 of those located in California. This totals $1.4 billion in suspended payments, according to Brandt.
“I’m not looking to catch the good people,” Brandt said. “It’s inevitable that we’re going to catch some good people in the net … A few people didn’t know they were affiliated with some bad people, and that’s unfortunate. But then they learn, and they figure that out and hopefully move on.”
