WASHINGTON--On Monday, the Department of Justice, the Department of Health and Human Services and CMS announced the details of a two-year initiative designed to eliminate deceptive providers of infusion therapy in South Florida.

The agencies are zeroing in on the area because of a steep surge in fraudulent Medicare billing for infusion, particularly infusion treatments for HIV/AIDS patients, officials said during a press call for health care journalists. Medicare billing for infusion services in South Florida is disproportionately high, HHS said, tripling from 2004 to 2005 to 15 percent of national billing.

HHS said its latest anti-fraud initiative follows similar demonstration projects that target fraudulent billing by DMEPOS suppliers in South Florida and Southern California, and home health agencies in the greater Los Angeles and Houston areas. According to HHS, "these geographic areas have shown a high frequency of DMEPOS or home health care fraud. South Florida is also one of the high-risk areas for fraudulent billing by providers of infusion therapy."

Under the demonstration, providers in several South Florida counties will be required to reapply to be qualified Medicare infusion therapy providers within 30 days of notification from CMS or their billing privileges will be revoked, Herb Kuhn, the agency's acting deputy administrator, said during the call.

But the National Home Infusion Association said it has asked CMS "for an immediate and public clarification that home infusion therapy providers are not the subject or the target of the planned demonstration program."

Indeed, an HHS fact sheet released Monday defined "infusion providers" subject to the demonstration as "clinics or solo practitioners located in South Florida who provide intravenous infusion therapy and/or intramuscular and subcutaneous injections in the office setting." The fact sheet said "infusion providers shifting from infusion to other procedure codes to avoid detection and bypass administrative actions" would also be included.

According to a press release posted on the NHIA Web site:

"Unfortunately, the 'infusion providers' at issue were not described in any detail in the materials released to the public, but virtually every media story following the announcement assumed that CMS was referring to home infusion therapy providers. After speaking with CMS officials and others, it is now apparent that home infusion therapy providers were not the entities that CMS and DOJ investigated or which will be subject to the new demonstration program.

"The National Home Infusion Association (NHIA) has asked CMS for an immediate and public clarification that home infusion therapy providers are not the subject or the target of the planned demonstration program. Several media organizations have mistakenly interpreted the materials released to the public as an indictment of the home infusion therapy industry. Particular home infusion therapy providers are being cited in the press as examples of the types of infusion providers that CMS is targeting in its demonstration program. CMS should act promptly to clarify this situation. Home infusion therapy providers should not [be] lumped together in the public's mind with entities that are being accused of committing serious acts against beneficiaries and the Medicare program. Likewise, the patients being served by home infusion therapy pharmacies should not have to endure unnecessary stress over concerns that need not exist."

In its newsletter last week, the American Association for Homecare noted that "HHS and CMS offices expect only a 1-2 percent overlap in those applying for both infusion therapy and HME provider status, according to the CMS officials at the press conference."

To view the HHS press release about the demonstration, click here.

To view the NHIA press release in full, click here.