CMS Contractors' Aggressive Enforcement Raises Alarm for Home Care Advocates

Advocates are raising concerns about the impact of enforcement actions by CMS's network of oversight contractors — Medicare Administrative Contractors (MACs), Review and integrity contractors, and related entities — on home health and hospice providers, according to a story from the National Alliance for Care at Home.

Katie Wehri, vice president of regulatory affairs, quality and compliance for the National Alliance for Care at Home, cited a lack of consistency in how the processes are applied and the autonomy contractors have been given to use the affiliations clause.

The affiliations clause allows CMS to deny or revoke Medicare enrollment based on a relationship posing an undue risk of fraud, waste or abuse, and the Alliance says CMS is floating expansion of that provision in the home health proposed rule.

The story highlights a case of an Arizona hospice owner whose Medicare privileges were revoked after a contractor labeled an established hospice as new and placed it under Provisional Period of Enhanced Oversight with automatic 100% claim review, resulting in revocation, a 10-year bar, and placement on a preclusion list.

LeadingAge, representing nonprofit home health, hospice, and aging services providers, submitted a March 30 response to CMS's CRUSH initiative citing a lack of transparency, timely information, and due process regarding Medicare Administrative Contractor operations in California, Nevada, and Arizona.

Wehri acknowledged recent progress on transparency, noting that CMS on September 30 directed MACs to post quarterly Targeted Probe and Educate results on their websites effective November 2 to standardize how denial information is shared with providers.