A Perfect Storm Brewing

Storm clouds for home care have gathered over Washington as lawmakers look for places to cut Medicare and fund other health care priorities in the new Congress. It's more likely that Congress will push for sweeping cuts this year rather than next. In 2008, a big election year, no one will want to rock the boat. So it's important to shore up broad support for home care.

The number of ominous signs on the horizon has grown recently.

Congressman Pete Stark, D-Calif., who chairs the House Ways and Means Subcommittee on Health, is looking for more than $100 billion in cuts over five years in order to fund health care proposals, such as expanding of the number of children covered under Medicaid and the State Children's Health Insurance Program. During a hearing in May, Stark warned that cuts are in the works, noting that, “It's going to be a busy summer.”

Further reductions to oxygen therapy reimbursement in the form of a 13-month cap are at the top of some of the lists circulating on Capitol Hill identifying potential budget cuts.

During a May 9 press conference about Medicare fraud in South Florida, Department of Health and Human Services Secretary Michael Leavitt said those fraud cases will “lead to changes in how we interact with the durable medical equipment industry.” This sentiment will be used to justify further reductions in payments for home care therapies and equipment provided by law-abiding providers.

In response to that press conference, AAHomecare issued a statement reiterating the industry's support for fighting fraud. We also pointed out that Medicare and its contractors have ample existing authority and regulatory leeway to stamp out much of the fraudulent activity at issue — but they have failed to use those tools effectively.

The Centers for Medicare and Medicaid Services could do more to prevent fraud from occurring in the first place. What we really need is better enforcement and clear, up-to-date regulations that target fraud and abuse but that do not unduly burden providers who make every effort to follow the rules.

A March 2007 HHS Office of Inspector General report presented nearly a dozen recommendations that Medicare should take to improve enforcement, many of those being front-end measures that would curb fraudulent claims before payments are made.

This cycle is unfortunate: Tax dollars are stolen, Medicare and Congress respond with increasingly complex regulations that burden small, law-abiding providers and the press conveys a distorted picture of home care.