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Monday, July 29, 2013

CMS Halts New Medicare Provider and Supplier Enrollment in Three Cities

by James Swann

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What do Miami, Chicago, and Houston have in common? As of July 30, the three cities and some surrounding counties will all be under a six-month moratorium from CMS for the enrollment of certain Medicare providers and suppliers, according to a July 26 notice. In Miami and Chicago, new home health agencies will be barred from enrolling in Medicare, while in Houston new ambulance providers and suppliers will be blocked. 

The moratoria were based on data analysis of the three areas that indicated they were all high risks for fraud and abuse. For example, Miami-Dade county, one of 26 counties in the country with more than 200,000 Medicare beneficiaries, averaged 38 home health agencies per 100,000 beneficiaries. In contrast, the remaining 25 scounties averaged two home health agencies per 100,000 beneficiaries.

The Affordable Care Act granted the HHS secretary authority to impose temporary moratoria, but this is the first time the authority has been used. Sens. Orrin Hatch (R-Utah), Tom Coburn (R-Okla.), and Chuck Grassley (R-Iowa) have sent three letters to HHS over the past few years, asking for information on why no temporary moratoria had been issued. In a July 26 statement, Hatch said he was pleased with the CMS moratoria announcement, even though it took three years. 

 
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