CMS Announces Extension of Enrollment Moratoria for Home Health and Ground Ambulance Suppliers and the Inclusion of Four New Metropolitan Areas: Fort Lauderdale, Detroit, Dallas and Houston

On January 30, 2014, CMS announced new temporary moratoria on home health agency enrollments in four metropolitan areas: Fort Lauderdale, Detroit, Dallas and Houston.  The moratoria will also include enrollments of new ground ambulance suppliers in the greater Philadelphia area.  CMS indicated that it would also be extending the current enrollment moratoria of home health agencies in Chicago and Miami and ground ambulance suppliers in Houston for an additional six-month period.  While no new provider or supplier applications will be approved in these areas, existing providers will be able to continue to provide and bill for services.  The new and extended moratoria went into effect on Friday, January 31, 2014 with an expected duration of six months.  CMS noted it will continue to monitor beneficiary access to care in the affected areas.

Enrollment moratoria are one of the tools CMS utilizes to prevent fraud in areas of known risk.  CMS, in conjunction with HHS, the OIG and DOJ determined that fraud trends justified the imposition of a moratorium on home health agencies and ambulance suppliers in the specific geographic areas.  Key factors in the fraud risk determination included (1) a disproportion number of providers and suppliers relative to beneficiaries, and (2) extremely high utilization.

In light of the fraud risks and increased scrutiny in the areas of home health and ground ambulance services, providers and suppliers are strongly encouraged to proactively examine documentation and billing practices and develop effective compliance policies.

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