The CMS is extending a national ban on adding new hospice and home health agencies to Medicare by another six months, according to an announcement on Thursday.
These providers continue to pose a major fraud risk to the federal healthcare program despite the initial pause on new enrollments that began in May, the agency explained. Another six months will give the CMS more time to weed out bad actors in the sector and monitor providers for fraud, it added.
Under the new ban extending through June 13, hospice and home health agencies also cannot reenroll following a change in majority ownership. Regulators have been concerned about rapid shifts in who owns home health agencies and hospices, particularly as private equity firms buy more stakes in these markets. They fear aggressive billing tactics under PE ownership may be harming beneficiaries, while frequent ownership shifts could indicate fraud schemes in which bad actors exploit lagging Medicare oversight.
Unlike the initial ban, though, those already enrolled in Medicare will be able to add new practice locations. The CMS previously prohibited the agencies from expanding to stop bad actors from operating fraud networks under an existing enrollment.
The CMS also said on Thursday that it will continue fingerprint-based background checks on home health and hospice operators, more intensive enrollment screenings and review programs before and after claims are submitted to spot and prevent fraud among these providers.
The extension builds on CMS' broader fraud enforcement efforts, including October's targeted two-day operation of home health agencies and hospices in California, which led to 145 providers losing their Medicare billing privileges, the agency reported.
Not only that, but the CMS issued a final rule earlier this month, widening its efforts to crack down on healthcare fraud, waste and abuse in Medicare. The rule expanded the agency’s authority to revoke Medicare enrollment across all provider types retroactively to the date a provider breaks the program's rules. This bolsters the CMS’ ability to recover improper payments.
Under the rule, the CMS is now able to boot providers if their owners or managing organizations land in hot water with Medicare and other healthcare programs, like Medicaid.The agency also gained greater enforcement authority to kick home health agencies, hospices and medical equipment suppliers from Medicare if they fail to reapply to the program after a change in majority ownership since these specific provider types are subject to report these changes to the federal government.
Home health providers have generally supported the government's efforts to crack down on healthcare fraud in their markets. However, they've raised concerns about the national ban on new enrollments, worrying it would prevent legitimate providers from opening or expanding to serve their communities.
Narrowing the extended ban by allowing practice expansions alleviates some of these concerns, the National Alliance for Care at Home said on Thursday. This allows home health agencies and hospices with clean track records to meet patient demand for these necessary services, the Alliance explained
