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Medicare & Medicaid News

Obamacare Helping Medicare Fight Fraud in Several States

CMS extends moratoria for enrolling ground ambulance suppliers, home health agencies in targeted high risk areas; regular service uninterrupted

July 30, 2014 – Obamacare is coming in handy for the Centers for Medicare & Medicaid Services (CMS) again, but this time it is in the unusual area of helping the agency fight fraud, waste, or abuse. CMS announced yesterday it is extending its enrollment moratoria on new grand ambulances in the Houston and Philadelphia metropolitan areas and new home health agencies in the metropolitan areas of Chicago, Fort Lauderdale, Detroit, Dallas, Houston, and Miami.

(The full list of extended moratoria counties is below news report).

CMS Administrator Marilyn Tavenner said the extension is necessary because the significant potential for fraud, waste and abuse continues in these areas.  CMS used this powerful Affordable Care Act tool twice before to fight fraud, safeguard taxpayer dollars and ensure access to care is not interrupted.  

 

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Medicare Fraud Prevention System Finds $210 Million in Improper Payments in Second Year

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June 25, 2014

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Factors that CMS considered in imposing the provider enrollment moratoria include a disproportionate ratio of providers and suppliers relative to beneficiaries, and law enforcement activity in these areas.  

Existing providers and suppliers can continue to deliver and bill for services, but no new provider and supplier applications will be approved in these areas.  The six-month extension of the moratoria in these areas was announced in a notice issued today in the Federal Register.

This latest six-month extension of the existing moratoria is effective beginning Wednesday, July 30; CMS may lift the moratoria earlier or extend it another six months by issuing another notice in the Federal Register.  During the moratoria period, CMS and the affected States will continue to monitor access to care to ensure that Medicare, Medicaid and CHIP beneficiaries are receiving the services they need.

Prior to imposing and extending these moratoria, CMS consulted with the appropriate State Medicaid Agencies and with the appropriate State Department of Emergency Medical Services to determine if the moratoria would create an access to care issue for Medicaid and CHIP beneficiaries in the targeted locations and surrounding counties.

All of CMS’ state partners were supportive of CMS analysis and proposals, and together with CMS, determined that these moratoria will not create access to care issues for Medicaid or CHIP beneficiaries. CMS also reviewed Medicare data for these areas and found there are no current problems with access to HHAs or ground ambulance suppliers.

Section 6401(a) of the Affordable Care Act added a new section 1866(j)(7) to the Social Security Act (the Act) to provide the Secretary with authority to impose a temporary moratorium on the enrollment of new Medicare, Medicaid or CHIP providers and suppliers, including categories of providers and suppliers, if the Secretary determines a moratorium is necessary to prevent or combat fraud, waste, or abuse under these programs.

The Federal Register notice can be downloaded by clicking here.

TABLE 1: Home Health Agencies and Home Health Agency Sub-units Moratoria Extension Locations

City and State

Counties

Fort Lauderdale, FL

Broward

Miami, FL

Miami-Dade

Monroe

Detroit, MI

Macomb

Monroe

Oakland

Washtenaw

Wayne

Dallas, TX

Collin
Dallas
Denton
Ellis
Kaufman
Rockwall
Tarrant

Houston, TX

Brazoria Chambers
Fort Bend Galveston
Harris
Liberty Montgomery
Waller

Chicago, IL

Cook
DuPage,
Kane,
Lake,
McHenry
Will

TABLE 2: Part B Ground Ambulance Supplier Moratoria Extension Locations

City and State

Counties

Houston, TX

 

Harris
Brazoria
Chambers
Fort Bend
Galveston
Liberty
Montgomery
Waller

Philadelphia, PA

Bucks (PA)

Delaware (PA)

Montgomery (PA)
Philadelphia (PA)

Burlington (NJ)

Camden (NJ)

Gloucester (NJ)

 

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