We've got to act to protect consumers first. Whether they have traditionalhealth care coverage or managed care, we have to make sure they don't haveinferior care.... [W]e will never have a health care system as strong asit can be unless we strengthen our efforts to root out fraud and abuse inthe Medicare program.
Today President Clinton addressed the Service Employees InternationalUnion Legislative and Political Action Conference. In his speech, thePresident announced the addition of three new weapons to the anti-fraudarsenal to combat fraud and abuse in the home health industry. Inaddition, President Clinton called on Congress to take immediate action topass existing legislation toimprove consumers protections and quality health care.
FIGHTING FRAUD AND ABUSE IN HOME HEALTH CARE
Imposing Tough New Standards on Home Health Agencies Through a NewReenrollment Process. Under this new rule, the Health Care FinancingAdministration (HCFA) will re-enroll home health providers every threeyears. Home health agencies will be required to submit an independentaudit of its records and practices at the time of re-enrollment. The newregulations HHS will implement during the moratorium will apply to allhome health agencies -- making it easy to kick out "fly-by-night"operators who are more likely to cheat Medicare. Currently HCFA can kickproviders out of Medicare only if they have been convicted of fraud.
Doubling the Number of Audits and Increasing Claims Reviews to Weed outBad Apple Providers. HCFA will nearly double the number of comprehensivehome health agency audits it performs each year -- from approximately 900to 1800. They will also increase the number of claims reviews by 25percent from 200,000 to 250,000. This increased oversight will build onHHS efforts already underway to increase investigations, prosecutions, andaudits under Operation Restore Trust, the Department's comprehensiveinitiative.
IMPROVING CONSUMER PROTECTION AND QUALITY HEALTH CARE
The President also called on Congress to pass two other bills currentlybefore the legislative body that he has already endorsed. (1) Put inplace anti-gag rules that give patients the right to know their treatmentoptions and (2) prevent health plans to discriminate on the basis ofgenetic information. The President also urged Congress to passlegislation to adopt the new strong federal standards on medical privacy.