CMS Places Moratorium On New Home Health Providers In Chicago Area

The Centers for Medicare & Medicaid Services has announced a moratorium on new home healthcare and ambulance services launching in the greater Chicago area.

The new enrollments cover all home health vendors for participation in the Medicare, Medicaid or Children's Health Insurance programs. It was enacted as of today, July 30, and will last for at least six months. It could be extended another six months at the discretion of the U.S. Department of Health and Human Services, which oversees the CMS.

The pause in enrollment of new providers is part of a plan to battle healthcare fraud, which can sometimes be rampant among home healthcare providers.

“CMS is using all available tools, including these moratoria, to combat fraud, waste and abuse in these vital health care programs,” said CMS Administrator Marilyn Tavenner. “While maintaining patients’ access to care, we are putting would-be fraudsters on notice that we will find and stop them before they can attempt to bill Medicare, Medicaid and CHIP.”

The HHS has been aggressively cracking down on healthcare billing fraud since Barack Obama was inaugurated in 2009. It has regularly held meetings with the media to discuss the issue, and announced high-profile arrests in Miami, Los Angeles and other parts of the nation that are considered healthcare fraud hotspots. It has recovered $14.9 billion in healthcare fraud judgments, settlements, and administrative penalties over the past four years.

The Windy City region is not commonly considered a fraud hotspot. However, federal agents have engaged in a couple of high-profile sweeps in the region that included arrests. And Sacred Heart Hospital on Chicago's West Side recently closed after its top executives were arrested and charged with Medicare fraud.

Moreover, CMS officials noted that several patterns among Chicago's home health providers suggested fraud. The included a large number of providers and suppliers relative to beneficiaries, rapid increases in enrollment applications from providers and suppliers, and extremely high rates of utilization.

The moratorium for Chicago includes Cook, DuPage, Kane, Lake, McHenry and Will Counties. CMS officials do not believe it will not affect the quality of care delivered to Medicare, Medicaid and S-CHIP enrollees in the region, officials said.

In addition to Chicago, CMS also imposed moratoriums on new enrollments in the Houston and Miami areas as well. The Houston moratorium focuses on new ambulance operators.