South Florida continues to be ripe for potential fraud, waste and abuse of Medicare and Medicaid through companies that provide nurses, therapists and other medical workers to patients in their homes, federal officials said this week in extending a moratorium on the licensing of new home health agencies in Miami-Dade, Monroe and Broward counties.
The six-month moratorium, allowed under the Affordable Care Act, extends a ban that started in Miami-Dade and Monroe in July 2013 and Broward in January 2014. The moratorium also applies to home health agencies in Detroit, Dallas, Houston and Chicago.
According to the Centers for Medicare and Medicaid Services, which oversees the public health insurance programs, the moratorium needed to be extended through January 2016 while the agency continues to monitor home health billing to root out fraud.
“A significant potential for fraud, waste, and abuse continues to exist in these geographic areas,” notes the announcement posted to the Federal Register on Tuesday. “The circumstances warranting the imposition of the moratoria have not yet abated.”
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While each of the regions with a moratorium is considered a “hot spot” by federal officials, Miami-Dade stands out for the numbers and amounts of Medicare payments made to home health agencies prior to the ban.
For example, Medicare payments for home health care in the Miami area increased from about $90 million in 2006 to more than $250 million in 2010, according to the Health Care Fraud and Abuse Control Program’s annual report for 2014 issued by the Department of Justice and the Department of Health and Human Services.
According to a 2012 report from the HHS Office of Inspector General (OIG), it didn't take much for federal authorities to spot abusive billing practices originating in Miami-Dade.
From the report: “In 2009, OIG found aberrant billing patterns in home health outlier payments in 24 counties nationwide. One county in Florida — Miami-Dade County — accounted for more home health outlier payments in 2008 than the rest of the nation combined.”
The abuses included billing Medicare and Medicaid for medically unnecessary services and filing claims for services that were never rendered.
While CMS did not provide current data on the numbers of home health agencies in South Florida, Linda Quick, president of the South Florida Hospital and Healthcare Association, said “there’s more than enough” operating in the region to continue to provide care for the elderly and low-income patients who rely on those services.
According to Quick, part of the problem is that in the mid-2000s Florida removed regulatory controls for home health agencies. The “certificates of need” required would-be home health agencies to demonstrate a need for services in the county where they intended to operate.
“When we eliminated the certificate of need,’’ Quick said, “we left ourselves with no market-entry regulation to speak of. Any two people with a Rolodex and with some nurses aides ... were eligible to call themselves a home health agency and bill the federal government.”