Opening a Medicare Home-Health Agency in Texas? Think Again

A few bad apples can spoil the bunch, the saying goes, and Medicare home-health agencies and nonemergency ambulance providers in several states are living proof. Elevated fraud and abuse concerns in six states recently led Medicare to extend an enrollment prohibition for new home-health agencies and nonemergency ambulance providers.

The extension lasts for six months and covers Florida, Texas, Illinois, Michigan, Pennsylvania, and New Jersey. The decision to renew the temporary moratoria was made after consulting with local law enforcement.

Home-health agencies are hard to keep track of and can be prone to fraud risks, Judith Waltz, a health-care attorney with Foley & Lardner LLP in San Francisco, told me. For example, home-health agencies don’t provide clinical care out of a central location, instead relying on caregivers who visit patient homes, making it hard to know exactly what goes on, Waltz said.

“I think the idea behind the moratoria is that these are easy-to-access sectors, that enrollment won’t screen them out effectively, and that it takes time for the CMS to catch up with fraudulent providers,” Waltz said.

The Medicare enrollment moratoria were originally imposed in July 2013 and covered a few counties in Florida, Illinois, and Texas. They were expanded to cover all six states in July 2016.

The enrollment moratoria authority was created under the Affordable Care Act and designed to give the government the power to shut down new Medicare enrollments in health-care sectors prone to fraud and abuse.

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