CMS to Adopt a "Zero Tolerance" Position on Bad Home Care Actors

The Government Accountability Office (GAO) has issued a report that finds CMS lax in its controls to limit fraud and abuse in the Medicare home health payments. The report recommended that CMS:
1. perform criminal history background checks on key personnel listed on the HHA enrollment application.
2. Conduct post-payment medical review on claims submitted by HHS with high rates of improper billing identified through prepayment review;
3. Revoke an agency's Medicare billing privileges for a pattern of submitted claims that are falsified, for persons who do not meet coverage criteria or for services that are not medically necessary, and
4. Furnish the physician who certifies/recertified the plan of care wiht a statement of home care services furnished.

CMS has agreed to consider an additional ground for revokation of billing privileges and to contact physicians regarding home health claims with high therapy utilization and outlier claims as a check on high home health payments.