July 27, 2013 in Business

Crackdown limits health-care providers

New enrollments banned in three high-fraud areas
Kelli Kennedy Associated Press
 

MIAMI – For the first time in history, federal health officials said Friday they will ban certain types of Medicare and Medicaid providers in three high-fraud cities from enrolling in the taxpayer-funded programs for the poor as part of an effort to prevent scams.

The strict moratoriums, which start Tuesday, give federal health officials unprecedented power to choose any region and industry with high fraud activity and ban new Medicare and Medicaid providers from joining the programs for six months. They wouldn’t ban existing providers.

The administrator of the Centers for Medicare and Medicaid Services said the agency is targeting providers of home health care in eight counties in the Miami and Chicago areas. All ambulance providers would be banned in eight counties in the Houston area.

The moratorium will also extend to Children’s Health Insurance Program providers in the same areas, agency administrator Marilyn Tavenner said in a statement.

It’s unclear how many providers will be shut out of the programs.

There were 662 home health agencies in Miami-Dade County in 2012 and the ratio of home health agencies to Medicare beneficiaries was 1,960 percent greater in Miami-Dade than elsewhere, according to federal figures.

South Florida, long known as ground zero for Medicare fraud, has also had several high-profile industry prosecutions.

In February, the owners and operators of two Miami home health agencies were sentenced for their participation in a $48 million Medicare fraud scheme.

The number of home health providers in Cook County, Ill., increased from 301 to 509 between 2008 and 2012. There were 275 ambulance suppliers in Harris County, Texas, in 2012. The ratio of providers to patients in both regions was also several hundred times greater than in other counties, federal health officials said.

Officials for the Department of Health and Human Services inspector general lobbied hard to ensure moratorium power was included under the Affordable Care Act.

Federal officials have been reluctant to use one of its most powerful new tools, worrying moratoriums may harm legitimate providers and hamper patients’ access to care.

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