Moratorium on Certain Medicare Providers in High fraud Areas

Last Week, U.S. Senators Orrin Hatch (R-Utah), Chuck Grassley (R-Iowa), and Tom Coburn (R-Okla.) welcomed action taken by the Centers for Medicare and Medicaid Services (CMS) to crack down on waste, fraud, and abuse within the Medicare program. The agency announced its decision to impose a temporary moratoria on the cities of Miami and Chicago for home health providers and on the city of Houston for ambulance providers for Medicare after the Senators repeatedly called on CMS to utilize the tools provided within the Patient Protection and Affordable Care Act (PPACA) to crack down on potential fraud by certain Medicare providers.

“While it’s certainly better late than never, it’s unfortunate that it took CMS three years to use the tools it’s had to protect seniors, who rely on Medicare, from fraud and abuse,” said Hatch, Ranking Member of the Senate Finance Committee that has oversight jurisdiction over the Medicare program. “With CMS finally acting to crack down on fraud in high-risk areas like Miami and Houston, America’s seniors will be better protected from those wishing to game the system putting their care in jeopardy, while helping shore up Medicare’s finances. I hope to see more action like this from CMS. The fact is too many bad actors are preying on the largesse of these programs and we need to do a better job of stopping them.”

“Just this week, a news story described cuts at the Health and Human Services inspector general’s office,” Grassley said. “It worries me that the watchdog that protects the taxpayers from waste, fraud and abuse is forced to let investigations fall by the wayside. The moratoriums are especially good news in that context. There’s no shortage of bad actors to defraud the taxpayers, and the number gets bigger all the time, so it’s good to see the Administration at last using this new tool to fight fraud.”

“I applaud CMS Administrator Marilyn Tavenner and her team for using authorities under current law to temporarily halt the enrollment of new Medicare providers or suppliers in key areas that are especially subject to fraud, waste, or abuse,” said Coburn. “I am glad to see CMS follow recommendations from the Inspector General, as well as myself and colleagues, that they should use this targeted tool to protect taxpayers and beneficiaries. While reducing fraud will not solve Medicare’s broader financing challenges, using the full range of authorities and tools to reduce fraud is an important responsibility in managing the program.”

Under PPACA, CMS can impose a temporary enrollment moratorium on new Medicare providers and suppliers when the agency determines that there is a significant potential for waste, fraud, or abuse by the applicant type or geographic area. Despite repeated letters from the Senators over the past three years as well as evidence from investigations by the U.S. Dept. of Health and Human Services Office of Inspector General (HHS-OIG) that demonstrate this tool would stop Medicare fraud, this is the first time CMS has exercised its authority to impose temporary moratorium.

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