New GAO Report Reaffirms Need for Reforms to Prevent Medicare Fraud and Abuse

Home Healthcare Community Calls for Program Integrity Reforms to Strengthen Medicare, Protect Patients and Reduce Costs

WASHINGTON, Oct. 12, 2012 /PRNewswire-USNewswire/ -- Leaders in the home healthcare community today called for targeted Medicare reforms to combat fraud and abuse in response the U.S. Government Accountability Office (GAO) report on healthcare fraud, "Types of Providers Involved in Medicare, Medicaid, and the Children's Health Insurance Program Cases."

The Partnership for Quality Home Healthcare – a national coalition representing more than 1,500 community- and hospital-based home health agencies nationwide – strongly supports program integrity reforms to target and prevent fraud and abuse.  Data analyses from the Medicare Payment Advisory Commission (MedPAC) demonstrate that Medicare fraud in home health is largely isolated in a few select areas of the country, suggesting that targeted reforms can successfully identify – and eliminate – fraudulent activity from the Medicare program.

The Partnership has been working with lawmakers and community leaders for more than a year to develop proposals for targeting fraud and abuse and strengthening the Medicare skilled home healthcare benefit.   A package of suggested reforms — called the "Skilled Home Healthcare Integrity and Program Savings" (SHHIPS) proposal — includes provisions that would eliminate the possibility of overpayment by preventing payment of aberrant claims before they are made and by strengthening claims review processes and conditions of participation standards.

Provisions of the home healthcare community's package draw from a 2009 proposal that capped Medicare outlier claims at 10 percent to curb fraudulent billing practices.  The proposal, which was adopted as part of the Affordable Care Act (ACA), achieved an estimated savings of $853 million in 2010 alone and an estimated $11 billion over 10 years.  The successful policy, which prevents payment for aberrant claims before they occur, underscores the need to reform Medicare's current "pay and chase" practices.