Today President Clinton added three new weapons to the anti-fraud arsenal to combat fraud and abuse in the home health industry. The President announced:
(1) an immediate moratorium on all new home health providers coming into the Medicare program to allow the Health Care Financing Administration to implement new regulations to prevent fly-by-night providers from entering Medicare;
(2) a new renewal process for home health agencies currently in the program to ensure that all Medicare providers have to abide by these tough new regulations; and
(3) a doubling of audits that will help weed out bad apple providers. These actions are consistent with recommendations to reduce fraud in home health by the Inspector General at the Department of Heath and Human Services following a recent report on fraud in the home heath care industry. The new initiatives announced today build on the President's unprecedented record of fighting fraud and abuse in Medicare and Medicaid.
Took Strong Action to Fight Fraud and Abuse Right When He Took Office.
The President's first budget closed loopholes in Medicare and Medicaid to crack down on fraud and abuse. In 1993, the Attorney General put fighting fraud and abuse at the top of the Justice Department's agenda. Through increased resources, focused investigative strategies and better coordination among law enforcement, the Justice Department increased the number of health care fraud convictions by 240 percent between FY1993 and FY1996 and saved taxpayers more than $20 billion.
Launched Operation Restore Trust -- a Comprehensive Initiative to Fight Fraud and Abuse in Medicare and Medicaid.
Two years ago, the Department of Health and Human Services launched Operation Restore Trust, a comprehensive anti-fraud initiative in five key states. Since its inception, Operation Restore Trust has identified more than $187.5 million in fines, recoveries, settlements, audit disallowances, and civil monetary penalties owed to the Federal Government.
Obtained Additional Resources to Fight Fraud and Abuse When the President Signed Into Law Kassebaum-Kennedy Legislation.
In 1996, the President signed the Health Insurance Portability and Protection Act (Kassebaum-Kennedy) into law which, for the first time, created a stable source of funding for fraud control. This legislation is enabling HHS to expand Operation Restore Trust to twelve states.
Passed New Initiatives to Combat Fraud and Waste Proposed by the President in the Balanced Budget Act of 1997.
The Balanced Budget Act the President signed into law in August also included important new protections to fight fraud and abuse in Medicare and Medicaid. These new initiatives included: requiring providers to give proper identification before enrolling in Medicare; implementing new penalties for services offered by providers who have been excluded by Medicare or Medicaid; establishing guidelines for the frequency and duration of home health services; clarifying the definition of part-time or intermittent nursing care which will clarify the scope of the Medicare benefit and will make it easier to identify inappropriate services; establishing a prospective payment system (PPS) for home health services to be implemented in FY 1999, enabling HCFA to stem the excessive flow of home health care dollars; clearly defining skilled services so that home health agencies can no longer pad their bills with unnecessary services when a patient simply needs a simple service such as their blood drawn; and eliminating periodic interim payments that were made in advance to agencies and not justified until the end of the year.
PRESIDENT CLINTON UNVEILS NEW WEAPONS TO FIGHT FRAUD IN HOME HEALTH CARE
Today President Clinton added three new weapons to the anti-fraud arsenal to combat fraud and abuse in the home health industry. The President announced: (1) an immediate moratorium on all new home health providers coming into the Medicare program; (2) a new renewal process for home health agencies currently in the program; and (3) a doubling of audits that will help weed out bad apple providers. These actions are consistent with recommendations by the Inspector General of the Department of Heath and Human Services following a recent report on fraud in the home heath care industry.
DECLARING A FIRST EVER MORATORIUM TO STOP HOME HEALTH PROVIDERS FROM ENTERING THE PROGRAM.
The moratorium will give the Administration the opportunity to implement new regulations to provide better safeguards and protections to screen out problem home health providers. This action is consistent with strong evidence that the best way to stop fraud and abuse in our Medicare program is to prevent bad apple providers from ever entering the program. Home health care is the most rapidly expanding part of Medicare, with nearly 100 new home health providers entering Medicare each month. This moratorium --which will authorize the Department to grant exceptions for areas of the country with no access to home health care services --will be in place about six months until a new regulation. It will enable HHS to implement regulations to help prevent risky providers including:
Posting surety bonds of at least $50,000:
Home health agencies will be required to post surety bonds of at least $50,000 before they can enroll or re-enroll in Medicare. Surety bonds have proved to be an effective way to prevent bad apple providers from entering Florida's Medicaid program;
Requiring a minimum number of patients prior to seeking Medicare enrollment:
This will require home health agencies to establish an agency's experience in the industry before serving Medicare enrollees; and
Targeting home health agencies more likely to abuse Medicare:
This regulation will require home health agencies to submit detailed information about all of the businesses they own. This will ensure they do not use shaky financial transactions to exploit Medicare, such as preventing billing through companies that do not exist or are unauthorized to bill Medicare for services. This loophole allowed one home health agency in Georgia to defraud Medicare of $16.5 million before being found and convicted.
IMPOSING TOUGH NEW STANDARDS ON HOME HEALTH AGENCIES THROUGH A NEW RE-ENROLLMENT PROCESS.
Under this new rule, HCFA will re-enroll home health providers every three years. Home health agencies will be required to submit an independent audit of their records and practices at the time of re-enrollment. The new regulations HHS will implement during the moratorium will apply to all home health agencies --making it easy to expel fly-by-night operators who are more likely to cheat Medicare. Currently HCFA can kick providers out of Medicare only if they have been convicted of fraud.
DOUBLING THE NUMBER OF AUDITS AND INCREASING CLAIMS REVIEWS TO WEED OUT BAD APPLE PROVIDERS.
HCFA will nearly double the number of comprehensive home health agency audits it performs each year --from approximately 900 to 1800. HCFA will also increase the number of claims reviews by 25 percent from 200,000 to 250,000. This increased oversight will build on HHS efforts already underway to increase investigations, prosecutions, and audits under Operation Restore Trust, the Department's comprehensive initiative.
PRESIDENT CLINTON CALLS ON CONGRESS TO PASS EXISTING LEGISLATION TO IMPROVE CONSUMER PROTECTIONS AND QUALITY HEALTH CARE
Today in his speech before the Service Employees International Union (SEIU), President Clinton called on the Congress to take immediate action to pass existing legislation to improve consumers protections and quality health care. The President asked Congress to pass right away three bills currently before itthat he has already endorsed that would: (1) ensure women are allowed to stay in the hospital at least 48 hours after a mastectomy; (2) put in place anti-gag rules that give patients the right to know their treatment options; and (3) prevent health plans from discriminating on the basis of genetic information. The President also asked Congress to work to pass legislation to adopt the new strong federal standards on medical privacy.
Allowing Women to Stay in the Hospital at Least 48 Hours Following a Mastectomy
This legislation --sponsored by Representative DeLauro and Senator Daschle and already endorsed by the President --would ensure that a woman will be allowed to stay in the hospital at least 48 hours after undergoing a mastectomy. It would guarantee that decisions of when to leave the hospital are made between a woman and her doctor rather than a health plan. Earlier this year, the First Lady brought national attention to the horrifying practice of kicking women out of the hospital on the same day they undergo mastectomies. The President strongly encouraged the Congress to hold hearings and pass legislation on this important issue.
Implementing Anti-gag Rules for Private Health Plans.
Patients should have the right to be informed of all of their treatment options --not just the cheapest. The President has already banned gag rules that prevented doctors from telling Medicare and Medicaid patients about all their options for treatment. Today he is calling on Congress to do its part --pass legislation protecting patients in private health care plans so that no American is left in the dark about how best to treat his or her illness. President Clinton encouraged Congress to pass legislation similar to that proposed by Representative Ganske and Representative Markey.
Preventing Health Plans From Discriminating on the Basis of Genetic Information.
Important advances in genetics are offering new potential to identify hidden genetic disorders and spur early treatment. While these new strides will fundamentally change the way that we treat diseases, genetic information can also be used to discriminate against or stigmatize individuals. President Clinton called on Congress to pass legislation that will prevent health plans from denying or dropping coverage or raising premiums on the basis of genetic information. The President has already endorsed the principles of the legislation introduced by Representative Slaughter and Senator Snowe. In a similar vein, later this year the Administration will release a report which makes recommendations to prevent discrimination based on genetic information in the workforce. The President encourages the Congress to move forward on that issue as well.
Adopting Strong New Federal Standards to Protect Medical Privacy.
Medical records were once protected by family doctors --who kept handwritten records filed away. Today, revolutions in the health care delivery system mean that entire networks of insurers and health care professionals have access to this now computerized private and personal information. Today the President called on Congress to enact legislation to protect medical privacy in the information age and to adopt the new strong federal standards on privacy such as those issued by Secretary Shalala last week.