Center for Medicare and Medicaid Services (CMS) imposes first ACA Enrollment Moratoria to Combat Fraud

Last Friday, the Center for Medicare and Medicaid Services known as CMS, announced a moratoria on home health care companies and ambulance services in three areas of the country.  The Greater Houston area is one of those where the moratoria will effect people applying to be ambulance providers.

How did it get to this?  Houston has been one of the top places in the country for healthcare fraud for a very long time.   Harris County was the epicenter for the Scooter Scam.  In 2001, Medicare paid for 3,000 scooters vs 31,000 in 2002.  But Medicare fraud in the Houston area goes beyond durable medical equipment like scooters, it includes home health care fraud, ambulance fraud, and group-psycho therapy fraud.

What has been and still is an ongoing investigation, is how residents of group homes are taken by a van to day centers and Medicare is billed for ambulance rides and mental health services that are not provided.  Several indictments related to this fraud have already been administered and trials and convictions will be coming.  But the number of private ambulance providers is unbelievable.  Here is a link to a detailed story that appeared in the Houston Chronicle about this issue in October 2011.  http://www.chron.com/news/houston-texas/article/Some-Ems-companies-taking-Medicare-for-a-ride-2220817.php

Now, nearly two years later, CMS is putting this moratoria into place.  http://www.cms.gov/Newsroom/MediaReleaseDatabase/Press-Releases/2013-Press-Releases-Items/2013-07-26.html

Hopefully this will help the situation, but these individuals who defraud the Medicare and Medicaid system work overtime to find billing vulnerabilities in both programs to rip off not only taxpayers but the beneficiaries by stealing their healthcare dollars.  It is important that beneficiaries understand what fraud and abuse looks like and they report all suspicious behavior.

Barbara Parrott McGinity, LMSW

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