ICYMI: New MaineCare Fraud Reporting Highlights Need for Senator Collins’ Medicare Home Health Reform Bill

Reports of MaineCare provider suspensions and terminations come as Senator Marsha Blackburn joins Senator Collins' anti-fraud legislation as a cosponsor.

WASHINGTON, D.C. - As troubling new reports detail alleged fraud, abuse, and inadequate oversight involving MaineCare providers, U.S. Senator Susan Collins has introduced the Medicare Home Health Payment Integrity and Protection Act to combat similar vulnerabilities in the Medicare home health program by stopping fraudulent payments before they are made.

The legislation would provide the Centers for Medicare and Medicaid Services (CMS) with stronger tools to identify high-risk providers, authorize additional funding to investigate and prosecute organized schemes, and protect legitimate home health agencies from the financial consequences of payments made to fraudulent providers. Senator Marsha Blackburn (R-TN) has joined the legislation as a cosponsor.

"The recent allegations involving MaineCare providers are deeply troubling. While these cases in Maine involve Medicaid providers and my legislation focuses on the Medicare home health care program, they demonstrate the broader problem of unchecked health care fraud," said Senator Collins. "Fraud harms patients, wastes taxpayer dollars, and can reduce payments to honest providers, jeopardizing care for patients. My legislation would give CMS stronger tools to stop fraud before payments are made, provide additional resources to investigate and prosecute organized schemes, and help ensure that legitimate home health agencies are fairly reimbursed for the important care they provide."

Recent reporting by Maine news outlets has brought renewed attention to fraud and inadequate oversight of MaineCare, Maine's Medicaid program:

• Maine Public reported last week that the Maine Department of Health and Human Services (DHHS) suspended payments to five MaineCare providers based on "credible allegations of fraud." The state also terminated two providers because of serious health and safety risks and disenrolled 28 providers that had not submitted a claim within one year of enrollment. DHHS initially did not identify the providers but released their names following a request from Maine Public.

• The Maine Wire reported this week that a state termination letter found that Paradise Residential Services "failed to ensure individuals are protected from abuse, neglect, and exploitation." The letter cited residents repeatedly being left without staff, a lack of food, unsanitary conditions, inadequate employee training and background checks, and failures involving medication management. The outlet reported that Paradise received nearly $25 million through MaineCare before the state terminated its provider agreement in March.

Senator Collins' legislation would require additional identity verification before home health agencies can enroll in Medicare, impose heightened screening on agencies presenting an extreme risk of fraud, increase surveys and unannounced site visits, strengthen oversight of accrediting organizations, and authorize additional funding to investigate and prosecute organized home health fraud schemes.

The bill would also direct CMS to reset home health agency payment rates to account for fraud in the system and changes in the use of home health care since COVID-19. This would help prevent previous fraudulent spending from distorting reimbursements for legitimate providers nationwide, including the small and rural agencies serving many Maine seniors.

Click here to read Senator Collins' original bill announcement and here to read the complete text of the legislation.

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