Monday, September 15, 1997
Fighting Fraud in Home Health Care
We've got to act to protect consumers first. Whether they have traditional health care coverage or managed care, we have to make sure they don't have inferior care.... [W]e will never have a health care system as strong as it can be unless we strengthen our efforts to root out fraud and abuse in the Medicare program.-- President Clinton to SEIU
September 15, 1997
Today President Clinton addressed the Service Employees International Union Legislative and Political Action Conference. In his speech, the President announced the addition of three new weapons to the anti-fraud arsenal to combat fraud and abuse in the home health industry. In addition, President Clinton called on Congress to take immediate action to pass existing legislation to improve consumers protections and quality health care.
FIGHTING FRAUD AND ABUSE IN HOME HEALTH CARE
Declaring a First Ever Moratorium to Allow New Protections and Safeguards
to be Put in Place. 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.
Imposing Tough New Standards on Home Health Agencies Through a New Reenrollment Process. Under this new rule, the Health Care Financing Administration (HCFA) will re-enroll home health providers every three years. Home health agencies will be required to submit an independent audit of its 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 kick out "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. They 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.
IMPROVING CONSUMER PROTECTION AND QUALITY HEALTH CARE
Ban Drive-thru Mastectomies -- Allow Women to Stay in the Hospital at
Least 48 Hours Following a Mastectomy. The President strongly encourages
Congress to hold hearings and pass this bill -- legislation that would
ensure that a women 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.
The President also called on Congress to pass two other bills currently before the legislative body that he has already endorsed. (1) Put in place anti-gag rules that give patients the right to know their treatment options and (2) prevent health plans to discriminate on the basis of genetic information. The President also urged Congress to pass legislation to adopt the new strong federal standards on medical privacy.