Most newly enrolled CA hospice agencies flagged for fraud: CMS
A top official at the Centers for Medicare & Medicaid Services informed Congress on Tuesday that federal investigators have stripped billing privileges from three-fifths of newly enrolled hospice agencies that have continued to pop up in California, a state long riddled with healthcare fraud.
TL;DR
- Three-fifths of newly enrolled hospice agencies in California have had their billing privileges stripped by federal investigators.
- 35% of remaining California hospice providers flagged for corrective action.
- CMS is combating large-scale fraud schemes targeting Medicare and Medicaid, which cover over 170 million Americans and account for $1.8 trillion in annual spending.
- Sectors experiencing high rates of Medicare fraud include durable medical equipment, genetic testing, skin substitutes, home healthcare, and hospice.
- Medicaid fraud is rampant in areas like non-emergency medical transportation, personal care services, autism therapy, and substance abuse treatment.
- The Fraud Defense Operations Center (FDOC), or "Fraud War Room," has already led to over $1.8 billion in payment suspensions due to suspected fraud.
- CMS uses data-matching agreements with the Social Security Administration to cross-reference beneficiary records against the Death Master File.
- Critics argue that CMS and other agencies are not adequately implementing existing tools to combat fraud.