The Centers for Medicare & Medicaid Services (CMS) announced that it will extend the temporary moratoria on Medicare enrollment of new home health agencies and ambulance suppliers in specific locations within metropolitan areas in Florida, Illinois, Michigan, Texas, Pennsylvania, and New Jersey. CMS stated that HHS-OIG and the Department of Justice agree that a significant potential for fraud, waste, and abuse continues to exist in these geographic areas.
Section 6491(a) of the Affordable Care Act and 42 C.F.R. § 424.570 provide that CMS may impose a temporary moratorium on the enrollment of new Medicare, Medicaid, or CHIP providers and suppliers, including categories of providers and suppliers, if CMS determines that a moratorium is necessary to prevent or combat fraud, waste, or abuse. Pursuant to this authority, CMS issued a notice on July 31, 2013 imposing moratoria on the enrollment of home health agencies in Miami-Dade County, Florida and Cook County, Illinois and surrounding counties and on the enrollment of ground ambulance suppliers in the Harris County, Texas area and surrounding counties. On February 4, 2014, CMS imposed moratoria on the enrollment of home health agencies in Broward County, Florida, Dallas County, Texas and Wayne County, Michigan and surrounding counties and on the enrollment of ground ambulance suppliers in Philadelphia, Pennsylvania and surrounding counties.
CMS announced that in deciding to extend these enrollment moratoria, it considered law enforcement’s experience with ongoing and emerging fraud trends through civil, criminal, and administrative investigations. CMS also looked to its own data analysis, which showed strong indicators of risk.
CMS stated that it consulted with State Medicaid Agencies and State Departments of Emergency Medical Services to determine if the moratoria would create an access to care issue for Medicaid and CHIP beneficiaries. CMS also reviewed its Medicare data for the geographic areas and found that there are no current problems with access to home health agencies or ground ambulance suppliers in the targeted locations.
In accordance with 42 C.F.R. § 424.570(b), a temporary enrollment moratorium imposed by CMS remains in effect for six months. If CMS deems necessary, the moratorium may be extended in six month increments. CMS evaluates whether to lift or extend the moratorium before any subsequent moratorium period ends. If CMS decides to lift a moratorium, the provider or supplier types that were unable to enroll due to the moratorium will be designated to CMS’ high screening level for six months from the date the moratorium was lifted.