CMS Using Regional Enrollment Moratoriums to Cut Down on Fraud

Hoping to stem fraud and abuse in troublesome regions of the nation, the Centers for Medicare and Medicaid Services is imposing a temporary moratorium on enrollment for certain services covered by Medicare, Medicaid and Children’s Health Insurance Plan in three major metropolitan regions.

The moratorium applies to newly-enrolling home health agencies in the greater Chicago and Miami regions, and newly-enrolling ambulance services in the Houston metropolitan region. The moratoriums, authorized under the Affordable Care Act, cover Miami-Dade and Monroe Counties in Florida, Cook, DuPage, Kane, Lake, McHenry and Will Counties in Illinois, and Brazoria, Chambers, Fort Bend, Galveston, Harris, Liberty, Montgomery and Waller Counties in Texas.

The six-month moratoriums begin July 30, but CMS can lift them early or extend them for another six months. This is the first time the agency is using the authority granted in the health reform law, which enables CMS to continue to serve existing providers and suppliers, while being able to bring more resources to combat fraud and abuse.

The Partnership for Quality Home Healthcare, a trade group, applauded the moratorium and urged CMS to advance more targeted reforms. The 3,000-member partnership views program integrity efforts as preferable to across-the-board Medicare cuts and re-imposition of burdensome out-of-pocket costs for consumers, it said in a statement.