September 15, 1997

Fighting Fraud in Home Health Care


We've got to act to protect consumers first. Whether they have traditionalhealth care coverage or managed care, we have to make sure they don't haveinferior care.... [W]e will never have a health care system as strong asit can be unless we strengthen our efforts to root out fraud and abuse inthe Medicare program.

-- President Clinton to SEIU
September 15, 1997

Today President Clinton addressed the Service Employees InternationalUnion Legislative and Political Action Conference. In his speech, thePresident announced the addition of three new weapons to the anti-fraudarsenal to combat fraud and abuse in the home health industry. Inaddition, President Clinton called on Congress to take immediate action topass existing legislation toimprove consumers protections and quality health care.

Declaring a First Ever Moratorium to Allow New Protections and Safeguardsto be Put in Place. The moratorium will give the Administration theopportunity to implement new regulations to provide better safeguards andprotections to screen out problem home health providers. This action isconsistent with strong evidence that the best way to stop fraud and abusein our Medicare program is to prevent "bad apple" providers from everentering the program. Home health care is the most rapidly expanding partof Medicare, with nearly 100 new home health providers entering Medicareeach month.

Imposing Tough New Standards on Home Health Agencies Through a NewReenrollment Process. Under this new rule, the Health Care FinancingAdministration (HCFA) will re-enroll home health providers every threeyears. Home health agencies will be required to submit an independentaudit of its records and practices at the time of re-enrollment. The newregulations HHS will implement during the moratorium will apply to allhome health agencies -- making it easy to kick out "fly-by-night"operators who are more likely to cheat Medicare. Currently HCFA can kickproviders out of Medicare only if they have been convicted of fraud.

Doubling the Number of Audits and Increasing Claims Reviews to Weed outBad Apple Providers. HCFA will nearly double the number of comprehensivehome health agency audits it performs each year -- from approximately 900to 1800. They will also increase the number of claims reviews by 25percent from 200,000 to 250,000. This increased oversight will build onHHS efforts already underway to increase investigations, prosecutions, andaudits under Operation Restore Trust, the Department's comprehensiveinitiative.

Ban Drive-thru Mastectomies -- Allow Women to Stay in the Hospital atLeast 48 Hours Following a Mastectomy. The President strongly encouragesCongress to hold hearings and pass this bill -- legislation that wouldensure that a women will be allowed to stay in the hospital at least 48hours after undergoing a mastectomy. It would guarantee that decisions ofwhen to leave the hospital are made between a woman and her doctor ratherthan a health plan.

The President also called on Congress to pass two other bills currentlybefore the legislative body that he has already endorsed. (1) Put inplace anti-gag rules that give patients the right to know their treatmentoptions and (2) prevent health plans to discriminate on the basis ofgenetic information. The President also urged Congress to passlegislation to adopt the new strong federal standards on medical privacy.

September 1997

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September 15, 1997

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