CMS May Expand Home Health Payment Suspensions in Miami-Dade

In a November 23, 2008 article, The Miami Herald reports that a recent Federal court ruling may result in the Centers for Medicare & Medicaid Services (CMS) expanding the suspension of Medicare payments for home health agencies (HHA) in the Miami-Dade County of Florida. 

According to the article, a Federal judge in the U.S. District Court, Southern District of Florida recently denied a HHA's request to enjoin CMS from suspending its Medicare payments.  CMS apparently suspended the HHA's Medicare payments pursuant to Medicare regulations (42 C.F.R. 405.370 - 405.375) that provide for the suspension of payments if there is reliable information that an overpayment, fraud or willful misrepresentation exists. The Miami Herald also reports that, in response to the U.S. District Court ruling, a CMS representative indicated that the Federal court ruling would allow CMS to expand its efforts to look at other HHAs for payment suspensions and audits.   

At the October 2008 Fraud and Compliance Forum of Health Care Compliance Association/American Health Lawyers Association, CMS Acting Administrator, Kerry Weems, reported in a speech that CMS had suspended the payments of the top 10 Miami-Dade HHAs with the highest percentage of outlier payments in 2007 and is moving to recover any overpayments from the HHAs between 2004 and 2008.

For reference, the case that is the subject of The Miami Herald article is Home Care Services Provider, Inc. v. Leavitt, Case No. 1:2008cv22930.