Home-healthand medical transport companies in crosshairs
What to make of the federalgovernment extending its moratorium on allowing new medical providers to bill Medicare and Medicaid insix states?
Does CMS still need to geta handle on pre-screening providers before allowing them to bill?
Or is fraud is so rampantin those areas that CMS must weed out existing bad actors before allowing newproviders to enter?
Shutting down enrollment isa drastic move that can hurt honest providers. It also can limit patient accessto needed care. But it’s a necessary step for the federal government to effectively manage fraud in its programs.
The areas affected by theextension include home-healthcare and medical transport — two that are rifewith fraud.
Congress gave CMS the powerto shut down enrollments a few years ago, but CMS hesitated at first. Nudged byCongress, CMS started restricting enrollments in limited areas where fraud wasmost out of control.
The enrollments seem to bea qualified success, but it will take a few years to fully know if provider fraudhas started moving downward.
In the meantime, CMS istaking a smart approach to using its power to restrict enrollments. Moratoriaare targeted. The latest extensions, for example, impose home-health enrollmentlimits in Florida on just three of the worst counties. Plus, CMS now allowsexceptions to the moratoria if providers pass heightened screening.
Taking action beforecrooked providers can bill is the best answer to the old “pay-and-chase” model.It should also deter many would-be cheaters, especially organized fraud ringslooking to soak federal programs.
About the author: DennisJay is executive director of the CoalitionAgainst Insurance Fraud.