CMS Official Says Hospice, Home Health Moratoria Proving Effective

WASHINGTON—About 250 home health agencies and 50 hospices have been denied new Medicare licenses during the first five months of moratoria on enrollment—making it a successful effort, according to leadership at the Centers for Medicare & Medicaid Services (CMS). 

The agency believes the moratoria have been effective at curtailing fraud, Kimberly Brandt, the agency’s deputy administrator and chief operating operator, said during the opening session of the National Alliance for Care at Home Conference and Expo in Washington. 

“We’ve had huge drops in billings in some of the areas, especially hospice in California,” Brandt said, saying more information should be shared in the coming weeks. 

The initial six-month period for the twin moratoria for home health and hospice ends Nov. 13. CMS will then announce whether both, one or neither moratoria will continue for an additional six months. 

Brandt said the two moratoria, plus one that began in February (and ended in August) on Medicare enrollment for durable medical equipment (DME) providers, were all designed to allow the agency to catch up with an overwhelming oversight effort. 

“We’d kick people out of enrolling in DME and they’d go enroll in home health and hospice,” Brandt said. “We wanted to make sure bad ators couldn’t enroll in any of the three.” 

She also said the agency discussed the concept for at least a year before launching it. 

Expanded Anti-Fraud Efforts

CMS has also recently started sending letters to Medicare beneficiaries who have been enrolled in hospice in Califorinia and Nevada to alert them of their status and ensure they are aware. This is in response to beneficiaries being enrolled by fraudulent providers without their consent. 

“Our No. 1 concern is making sure people know what they’re being signed up for,” Brandt said. “It’s a wonderful benefit, we want them to die with dignity, we want them to have support at the end, but we also don’t want them signed up for the benefit” if they don’t need the care. 

The letter program could indicate that CMS may continue the hospice moratorium in some fashion—possibly regionally—after the November deadline, Alliance regulatory experts Betta Deblasio and Katie Wehri said in a packed hospice overview session at the event. 

They highlighted patterns that make hospices more likely targets of audits or other anti-fraud efforts, including: 

Live discharge rates over the national average (19%)
Being co-located hospices

• Being in one of the six states identified as high risk: California, Arizona, Nevada, Texas, Georgia and Ohio
• Having long lengths of stay 
• Being co-located hospices
• Having live discharge rates over the national average (19%)

They said CMS isn’t likely to share the full range of factors they’re looking for in order to focus oversight activities, but it’s important for providers to ensure their compliance and documentation are routine and up-to-date—and that there are good explanations if some of the numbers seem out of whack. 

Advocates praised the anti-fraud efforts but expressed concern that they could block legitimate providers and harm patients. 

“With the breadth of the moratoria nationwide, there could be areas that could have problems with access to care,” Denis Fleming Jr., chief government affairs officer for the Alliance, said in a panel session with Brandt. He and others said some providers have requested a “gold card” system for providers with good records of compliance. 

Brandt said CMS currently supports in-home care generally and hospice specifically, prioritizing the right to receive care and to live out the end of their lives in the location they choose. 

“I want to go after these scummy people who are running it for everyone else, but otoh I don’t want to go after providers that fall into the gap,” Brandt said.