Dive Brief:
- CMS has extended last year's lockout of new enrollments for home healthcare and ground ambulance providers in three cities where fraud seems common, as well as freezing out new providers elsewhere, the agency announced.
- CMS is temporarily blocking all new provider applications for Medicare, Medicaid and the Children's Health Insurance Program in areas were similar specialists are generating excessive claims. The moratorium on new providers took effect January 31.
- CMS has extended its ban to homecare providers in Chicago and Miami and ambulance providers in Houston. Cities affected by the new home health agency provider ban include Dallas, Detroit, Houston and Fort Lauderdale. Meanwhile no new ground ambulance providers will get to bill these programs for the next six months in Philadelphia.
Dive Insight:
As CMS sees things, it's a lot smarter to put new providers on hold than pay them and then pursue possibly fraudulent payments later. And that makes some sense. After all, an ounce of prevention really does beat a pound of cure, especially when you're talking about millions upon millions of potentially wasted taxpayer dollars. That being said, CMS can only hold off legitimate providers for so long. As the agency itself has said, this is an anti-fraud tactic that should only be used after carefully assessing the effects of such bans on access to care.