Partnership Responds to U.S. Senate Finance Committee Solicitation for Recommendations to Combat Fraud and Abuse

Jun 28, 2012, 10:22 ET from Partnership for Quality Home Healthcare

Initiatives designed to protect beneficiaries, providers, and taxpayers by preventing fraud and abuse before it occurs

WASHINGTON, June 28, 2012 /PRNewswire-USNewswire/ -- The Partnership for Quality Home Healthcare, a national coalition representing more than 1,500 skilled home healthcare agencies nationwide, responded to a recent solicitation by the U.S. Senate Finance Committee for recommendations that can strengthen the integrity of the Medicare and Medicaid programs. Dedicated to developing innovative reforms that will secure beneficiary access to quality home healthcare services, the Partnership has submitted a set of proposed reforms to prevent fraud and abuse; ensure accuracy, efficiency and value; and improve quality and outcomes.

"Fraud and abuse have long plagued the Medicare and Medicaid programs, and although traditional efforts to curb such problems have had a measurable effect, bad actors continue to find a way to enter virtually every segment of these programs, prey on beneficiaries, and make off with billions of taxpayers' hard-earned money," the Partnership's letter to the Senate Finance Committee read in part. "Partnership members have been working together for more than a year to develop policy solutions that we firmly believe will effectively combat fraud and abuse in the Medicare and Medicaid programs."

The Partnerships package of suggested reforms – called the "Skilled Home Healthcare Integrity and Program Savings" (SHHIPS) proposal – includes provisions that would eliminate the possibility of overpayment (a frequently documented problem plaguing the Medicare and Medicaid programs) by preventing payment of aberrant claims before they are made and by strengthening claims review processes and conditions of participation standards. 

The key strength of the SHHIPS proposal is its ability to combat fraud in a targeted manner. According to Medicare claims data and analyses from the Medicare Payment Advisory Commission (MedPAC), fraud and abuse is largely isolated in a few selected areas within the Unites States. For example, Medicare claims data reveal that 60 percent of all the abuse in home healthcare relating to Medicare outlier claims in 2009 occurred in just two of the nation's 3,143 counties. Similarly, analysis of Medicare data indicates that nearly 90 percent of all aberrant home health reimbursement occurs in a minority of counties in just five states.

Payment reforms included in the Partnership's response to the Senate Finance Committee are modeled on an existing program change that was previously advanced by the home healthcare community. In 2009, the community proposed a 10 percent cap on Medicare outlier claims to stem aberrant billing practices that were believed to be evidence of unchecked fraud and abuse. By preventing aberrant claims from being paid in the first place, home healthcare providers successfully piloted the replacement of the troubled "pay and chase" practice with a simple and logical "aberrant payment prevention" mechanism.  The proposal, which was adopted as part of the Affordable Care Act (ACA), has been estimated as saving $853 million in 2010 alone and an estimated $11 billion over 10 years.

Nearly 3.5 million Americans currently receive Medicare home healthcare services and the anticipated demand for skilled home healthcare services is expected to rise significantly due to projected growth in the nation's senior population, as well as the preference of the vast majority of seniors to receive care in their own home. Many healthcare treatments that were once only available in a hospital or other institutional settings are now being safely and effectively provided in patients' homes by skilled clinicians.

Home healthcare has proven to be a cost-effective source of budgetary savings due to its lower cost and its ability to reduce hospital admissions and readmissions.  For example, the Veterans Affairs Administration has reduced its health spending by a net 24 percent among Veterans and their dependents using comprehensive in-home care. Multiple demonstration programs and state reforms are now underway and are expected to provide equally powerful outcomes for the Medicare and Medicaid programs.

The Partnership praised the Senate Finance Committee for soliciting recommendations and added, "In closing, the Partnership for Quality Home Healthcare wishes to thank you for this opportunity to present our recommended legislative solutions for combating fraud and abuse in the Medicare and Medicaid programs.  We hope that our proposals will be of value in your important work and stand ready to serve as a resource in any capacity needed."

More information about the Partnership's recommendations to the Senate Finance Committee is available here.

The Partnership for Quality Home Healthcare was established in 2010 to assist government officials in ensuring access to quality home health services for all Americans. Representing more than 1,500 community- and hospital-based home healthcare agencies nationwide, the Partnership is dedicated to developing innovative reforms to improve the program integrity, quality, and efficiency of home healthcare for our nation's seniors. To learn more, visit To join the home health policy conversation, connect with us on Facebook, Twitter and our blog

SOURCE Partnership for Quality Home Healthcare