Confusion over Crackdown on Infusion Providers

WASHINGTON–On Monday, the Department of Justice, the Department
of Health and Human Services and CMS announced the details of a
two-year initiative designed to eliminate deceptive providers of
infusion therapy in South Florida.

The agencies are zeroing in on the area because of a steep surge
in fraudulent Medicare billing for infusion, particularly infusion
treatments for HIV/AIDS patients, officials said during a press
call for health care journalists. Medicare billing for infusion
services in South Florida is disproportionately high, HHS said,
tripling from 2004 to 2005 to 15 percent of national billing.

HHS said its latest anti-fraud initiative follows similar
demonstration projects that target fraudulent billing by DMEPOS
suppliers in South Florida and Southern California, and home health
agencies in the greater Los Angeles and Houston areas. According to
HHS, “these geographic areas have shown a high frequency of DMEPOS
or home health care fraud. South Florida is also one of the
high-risk areas for fraudulent billing by providers of infusion
therapy.”

Under the demonstration, providers in several South Florida
counties will be required to reapply to be qualified Medicare
infusion therapy providers within 30 days of notification from CMS
or their billing privileges will be revoked, Herb Kuhn, the
agency’s acting deputy administrator, said during the call.

But the National Home Infusion Association said it has asked CMS
“for an immediate and public clarification that home infusion
therapy providers are not the subject or the target of the planned
demonstration program.”

Indeed, an HHS fact sheet released Monday defined “infusion
providers” subject to the demonstration as “clinics or solo
practitioners located in South Florida who provide intravenous
infusion therapy and/or intramuscular and subcutaneous injections
in the office setting.” The fact sheet said “infusion providers
shifting from infusion to other procedure codes to avoid detection
and bypass administrative actions” would also be included.

According to a press release posted on the NHIA Web site:

“Unfortunately, the ‘infusion providers’ at issue were not
described in any detail in the materials released to the public,
but virtually every media story following the announcement assumed
that CMS was referring to home infusion therapy providers. After
speaking with CMS officials and others, it is now apparent that
home infusion therapy providers were not the entities that CMS and
DOJ investigated or which will be subject to the new demonstration
program.

“The National Home Infusion Association (NHIA) has asked CMS
for an immediate and public clarification that home infusion
therapy providers are not the subject or the target of the planned
demonstration program. Several media organizations have mistakenly
interpreted the materials released to the public as an indictment
of the home infusion therapy industry. Particular home infusion
therapy providers are being cited in the press as examples of the
types of infusion providers that CMS is targeting in its
demonstration program. CMS should act promptly to clarify this
situation. Home infusion therapy providers should not [be] lumped
together in the public’s mind with entities that are being accused
of committing serious acts against beneficiaries and the Medicare
program. Likewise, the patients being served by home infusion
therapy pharmacies should not have to endure unnecessary stress
over concerns that need not exist.”

In its newsletter last week, the American Association for
Homecare noted that “HHS and CMS offices expect only a 1-2 percent
overlap in those applying for both infusion therapy and HME
provider status, according to the CMS officials at the press
conference.”

To view the HHS press release about the demonstration,
click here.

To view the NHIA press release in full,
click here.