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health10h ago
Blocking New Medicare Home Health And Hospice Firms Won’t Stop Fraud
- Medicare has blocked new home health and hospice providers for at least six months, a move critics say aims to curb fraud but may restrict access.
- The article argues the ban could hinder access to care in rural and underserved communities where current firms lack competition.
- Critics say preventing new entrants may protect existing firms while failing to address actual fraud among current providers.
- The analysis notes the Government Accountability Office estimated about $100 billion in improper payments in 2023, a fraction of nearly $1 trillion in total program spending.
- The piece questions the shutdown of new entrants as a solution, suggesting stronger enforcement against existing bad actors instead.
- Hospice payment mechanics are identified as a core issue, with fixed daily rates potentially misaligning incentives over time.
- The author suggests boosting ownership transparency and preventing reuse of names by convicted operators as a potential fix.
- Some providers exist that operate on private pay only and do not participate in government programs.
- The piece notes CMS chair Mehmet Oz’s statements about blocking new entrants as a broader anti-fraud effort.
- The article contrasts the ban with the need to physically limit the access to care and ensure supply in underserved areas.
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