Temporary Moratoria on Enrollment of HHAs in Geographic Areas
The Department of Health and Human Services reached a determination to put a moratorium on home healthcare agency enrollment in Miami, Houston and Chicago based in part on the federal government's experience with the Health Care Fraud Prevention and Enforcement Action Team (HEAT), a joint effort between DOJ and HHS to prevent fraud, waste and abuse in the Medicare and Medicaid programs. The Medicare Fraud Strike Force teams are a key component of HEAT and operate in nine cities nationwide. This announcment is found in the July 29 Federal Register Notice.
Each Medicare Fraud Strike Force team combines the programmatic and administrative action capabilities of CMS, the analytic and investigative resources of the FBI and HHS-OIG, and the prosecutorial resources of DOJ's Criminal Division's Fraud Section and the United States Attorneys Offices. The Strike Force teams use advanced data analysis techniques to identify high billing levels in health care fraud hotspots so that interagency teams can target
emerging or migrating schemes along with chronic fraud by criminals masquerading as health
care providers or suppliers. The locations of the Strike Force teams are identified by analyzing
where Medicare claims data reveal aberrant billing patterns and intelligence data analysis
suggests that fraud may be occurring.
It is important to note that all of the moratoria target areas identified in this notice –
Miami, Houston, and Chicago – are Strike Force cities, and each of these areas has experienced intense, sustained criminal prosecution activity with respect to the provider and supplier types subject to these moratoria. In addition, CMS's own administrative investigations and oversight have been equally intense in these areas. Through CMS's own anti-fraud activities, in addition to the federal government's coordinated HEAT efforts, CMS has determined that home health agencies in Miami and Chicago and the surrounding areas, and ambulance companies in Houston and the surrounding area pose a significant risk of fraudulent activity.
The moratorium, effective July 30, is in effect for at least six months but can be extended in six-month increments. Extensions will be posted in the Federal Register. Once the moratorium is lifted, providers will be regulated to the highest screening level to enroll in federal programs.
The Affordable Care Act gives HHS the authority to impose temporary moratoria “to prevent or combat fraud, waste or abuse,” the notice states.
The Miami area has had a spotlight on it's HHAs for some time now. “Since 2011, the U.S. Attorney's Office for the Southern District of Florida has filed 41 home health fraud cases and charged 98 individuals that have resulted in 85 guilty pleas and eight trial convictions,” the notice states.
In the Chicago area, “the U.S. Attorney's Office for the Northern District of Illinois has filed approximately 11 home health fraud cases and charged 45 individuals that have resulted in 15 trial convictions,” the notice states.
The moratorium does not apply to “changes in practice locations, changes to provider or supplier information such as phone number, address or changes in ownership (except changes in ownership of HHAs that require initial enrollments ...),” the notice states.
The notice also imposes a moratorium on new ambulance suppliers in the Houston area that is not necessarily related to HHA's.