Home Health Agency Ban Extended and Expanded in South Florida

Posted on Health Care Law News by author

The Centers for Medicare & Medicaid Services (CMS) announced effective January 31, 2014, a six-month moratorium continues for new and pending applications for home health agency providers and suppliers in Miami-Dade and Monroe counties and begins in Broward County. The moratorium, invoked under the Affordable Care Act, also affects other large metropolitan cities such as Chicago, Detroit, Dallas, and Houston. The purpose of the moratorium is to protect taxpayer dollars and prevent fraud in areas of known risk, according to CMS.

These areas were selected to be included in the six-month moratorium because they were deemed fraud “hot spots” by federal officials due to the number of healthcare fraud-related criminal prosecutions in the regions, the ratio of home health agencies to Medicare beneficiaries compared to elsewhere, and the size of payments to those agencies compared to elsewhere, among other things. Since no new home health agency providers or suppliers will be allowed during this time, already enrolled providers and suppliers will be more closely monitored. The Centers for Medicare & Medicaid Services will focus the majority of their attention on home health billing during this time since south Florida home health agencies have been more lucrative compared to other counties in and around Florida.

During the following six months, existing providers and suppliers can continue to provide and bill for services, but no new provider or supplier applications will be approved. The moratoria period may be lifted early or can be extended for another six months. If extended and/or expanded, a notice will be issued in the Federal Register.

In addition, the extension of the moratoria applies to new enrollments for ground ambulance suppliers in the Houston metropolitan area, and a new moratorium will be implemented for ground ambulance suppliers in the Philadelphia area.