Finding Fraud, Feds Ban Home Health Agencies in South Florida

by | January 31, 2014 AT 3:10 AM

By Daniel Chang

Seeking to root out and deter fraud among agencies that provide nurses and therapists to Medicare and Medicaid beneficiaries in their homes, federal officials Thursday said they will lengthen a temporary moratorium on new home health agencies in Miami-Dade and Monroe counties. They also extended the ban to Broward for the first time.

The six-month moratorium, invoked under the Affordable Care Act, begins Friday and applies to new and pending applications for home health agency providers and suppliers in the three South Florida counties and Chicago, Detroit, Dallas and Houston.

Each of the areas targeted by the moratoriums were deemed fraud “hot spots” by federal officials, who considered a number of factors in assigning that distinction — including the number of healthcare fraud-related criminal prosecutions in a region, the ratio of home health agencies to Medicare beneficiaries and the size of payments to those agencies.

Among the 30 regions scrutinized by federal officials, Miami-Dade has the ignominious distinction as the area with the nation’s highest ratio of home health agencies to Medicare beneficiaries, and the highest payments to such agencies.

Broward ranks fifth in the ratio of agencies to beneficiaries, and sixth in amount of payments to agencies.

“Miami is king,’’ said an official with the Centers for Medicare & Medicaid Services who asked not to be identified.

During the moratorium, CMS officials will continue to monitor home health billing from enrolled providers to root out fraud, according to the agency's announcement.

Linda Quick, president of the South Florida Hospital and Healthcare Association, said extending the moratorium was “the right idea.’’

“We have an excess capacity in that field,’’ she added. “Any resident with a Rolodex and a home health aide thinks they’re a home health agency.’’

CMS' data shows that in 2012 there were 37.6 home health agencies per 10,000 Medicare beneficiaries (excluding those enrolled in Medicare Advantage plans) in Miami-Dade.

CMS officials compared Miami-Dade to 30 other counties with at least 200,000 Medicare beneficiaries. They found that Miami-Dade’s ratio of home health agencies per 10,000 beneficiaries was 1,960 percent greater than the other counties.

In Broward County, there were 11.2 home health agencies per 10,000 Medicare beneficiaries in 2012, for a ratio that was 89.8 percent greater than comparable counties.

South Florida home health agencies also have been more lucrative compared to other counties, CMS reported.

In Miami-Dade, such agencies received payments of $10,287 a year per average Medicare home health user, while in comparable counties those agencies received payments of $5,783 a year — a difference of 77 percent.

In Broward, home health agencies were receiving payments of $6,432 a year per average Medicare home health user, or about 19 percent more than the average for comparable counties.

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