A White House official reported this week that parts of the U.S. health care system have been infiltrated by organized crime groups.
As a result, a temporary freeze on new providers was implemented two weeks ago while the purported crisis is contained.
“They just need to have a Medicare beneficiary number or some of their ID, which is basically a credit card, and they can begin charging against the federal tax dollars that go into Medicare and Medicaid,” Centers for Medicare and Medicaid Services (CMS) administrator Dr. Mehmet Oz said. “That's one of the reasons we're seeing such high amounts of fraud in different parts of the country.”
The six-month nationwide moratorium was implemented by the CMS on May 15 and is applicable to Medicare enrollment of all new hospice and home health agency providers.
“We do not want to hurt the folks who are earnestly involved in hospice, durable medical equipment suppliers and personal care services,” Oz said on June 2. “They're good people in these businesses but we're going to slow down the growth of these sectors so we can get our arms around the problem.”
Payments to some 850 hospices in California, which accounts for almost half of all hospices statewide, have been suspended.
A multi-agency Hospice Fraud Task Force was created, and a moratorium on new hospice licenses remains in effect.
However, Oz said fraudsters have shifted to other areas, including home health care in California, where they are allegedly taking advantage of the Medicaid population using nefarious techniques and technologies.
"When we go after hospice in California, guess what happens? Hospice in Nevada went up sevenfold," he said. "Hospice in Arizona ... hospice in Texas ... they've all gone up."
Oz further noted that the rise in personal care attendants regionally is a red flag.
The U.S. Bureau of Labor Statistics shows that California employs some 796,890 personal care aides while New York employs about 566,160.
“These are organized criminal syndicates in many instances, and that's why being a personal care service attendant, which is again doing something that your family would normally do for you, carrying groceries upstairs, driving you somewhere, that job is now by twofold, the most common job in California and it's the most common job in New York.”
When questioned whether, if expanded, the nationwide 6-month moratorium would hurt employment and growth, Oz refused to rule out an extension.
"If you're defrauding our most vulnerable citizens in America, do not walk away from this threat," he said. "Run away from us because we're coming after you."