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CMS Extends Ban on New Home Health Agencies in Six U.S. Counties

August 12, 2015

The Centers for Medicare and Medicaid Services (CMS) announced that it is extending a moratorium on new home health agencies in several U.S. cities in an attempt to prevent fraud.

The six-month extension began on July 29 and applies to the following counties:

  • Cook County, Illinois
  • Harris County, Texas
  • Dallas County, Texas
  • Miami-Dade County, Florida
  • Broward County, Florida
  • Wayne County, Michigan

The counties that fall under the moratorium contain several major U.S. cities, including Houston, Chicago, and Detroit; more than 17 million people live in the six counties.

The Affordable Care Act gave CMS the authority to issue moratoriums on the enrollment of new Medicaid, Medicare, and/or CHIP providers if one is deemed “necessary to prevent or combat fraud, waste, or abuse under these programs.”

The moratoriums against Miami-Dade and Cook Counties began in 2013, while the rest were issued in 2014.

A 2009 report (pdf) by the Office of the Inspector General of the U.S. Department of Health and Human Services found questionable Medicare billing patterns in home health outlier payments in 24 counties nationwide, with Miami-Dade County accounting for more outlier payments than the rest of the country combined.

The abuses “included billing Medicare and Medicaid for medically unnecessary services and filing claims for services that were never rendered,” the Miami Herald reported on July 28.

Florida removed regulatory controls for home health agencies in the mid-2000s. Linda Quick, president of the South Florida Hospital and Healthcare Association, told the Herald that deregulation has led directly to increased Medicare fraud.

“Any two people with a Rolodex and with some nurses’ aides…were eligible to call themselves a home health agency and bill the federal government,” Quick said.

— by Matthew Ozga

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