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
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.
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
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.
Fort Bend Galveston
TABLE 2: Part B Ground
Ambulance Supplier Moratoria Extension Locations
City and State
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