Home Health Community Commends MedPAC and Committee Members for Reinforcing Need for Program Integrity Reform at House Ways & Means Hearing

News provided by

Partnership for Quality Home Healthcare

Mar 15, 2013, 04:19 ET

- MedPAC data underscores the need for home health community reform proposal to strengthen Medicare program integrity -

WASHINGTON, March 15, 2013 /PRNewswire-USNewswire/ -- The Partnership for Quality Home Healthcare today reiterated its support for program integrity reforms to curb fraud and abuse in the Medicare system, as recommended by the Medicare Payment Advisory Commission (MedPAC) and committee members. The home healthcare community continues to reinforce the need for increased efforts to strengthen Medicare to prevent fraud and abuse before it occurs for the benefit of patients, honest providers and American taxpayers.

At a hearing today before the House Ways and Means Health Subcommittee, testimony was presented on recommendations from the Commission's annual report to Congress. The recently released report recognizes the great value of home health stating, "The home health benefit provides a valuable service to beneficiaries and the Medicare program, particularly when it substitutes for a higher level of PAC or helps community-dwelling beneficiaries avoid hospitalizations."

As noted in previous reports, and confirmed again today by MedPAC, fraudulent and abusive billing practices in the home health sector are confined to isolated geographic areas of the country. The Commission has identified 25 counties (of the nation's 3,143 counties) where the highest levels of Medicare billing and suspected abuse are occurring, indicating that Medicare data allows government to identify and target fraudulent acts.

Based on this data, the home health community is calling on lawmakers to support program integrity reforms to reduce Medicare spending instead of implementing increased copayments on seniors or arbitrary cuts to Medicare reimbursement. The Partnership - a coalition of home health providers dedicated to developing innovative reforms to improve the program integrity, quality, and efficiency of home healthcare for our nation's seniors - has put forth a proposal entitled the Skilled Home Health and Integrity Program Savings (SHHIPS) Act to combat the payment of aberrant claims by tightening participation standards, strengthening claims review processes, and creating payment safeguards.

"We urge Members of Congress to focus on the isolated nature of Medicare fraud and abuse among home health agencies and recognize the positive outcomes that can be achieved through program integrity reform," stated Eric Berger, CEO of the Partnership. "We are committed to working with MedPAC and Congress to eradicate fraud and abuse so we may protect vulnerable seniors and taxpayers alike."

The Partnership expressed concerns at the Commission's recommendations to implement across-the-board cuts and a home health copayment. Both policies would have negative consequences and ultimately increase Medicare spending by driving patients into more costly, institutional settings. Before Congress considers more cuts to this sector, it should focus on areas like program integrity reform where there are clear savings that do not place beneficiary access at risk.

Furthermore, MedPAC has acknowledged that program integrity reforms could reduce Medicare costs. At a January 2013 meeting, MedPAC stated, "reducing utilization in the top 25 counties to the 75^th percentile (18.5 episodes per 100 beneficiaries) would have lowered [Medicare] spending by $840 million or five percent in 2011."

"Our proposal provides lawmakers with a pro-patient solution that can achieve long term cost-savings and sustainability in the Medicare program," added Berger. "Program integrity reform is critical to repairing the weaknesses that allow fraudulent individuals to take advantage of vulnerable seniors, taxpayers and the healthcare delivery system."

Home healthcare is widely recognized as patient preferred, clinically advanced and cost-effective, and is utilized by nearly 3.5 million Medicare beneficiaries nationwide.

The Partnership for Quality Home Healthcare was established in 2010 to assist government officials in ensuring access to skilled home healthcare services for seniors and disabled Americans. Representing more than 1,500 community- and hospital-based home healthcare agencies across the United States, the Partnership is dedicated to developing innovative reforms to improve the quality, efficiency and integrity of home healthcare. To learn more, visit www.homehealth4america.org. To join the home healthcare policy conversation, connect with us on Facebook, Twitter and our blog.

SOURCE Partnership for Quality Home Healthcare