Analysis: Prior Authorizations and Advocacy

CMS is really trying hard to combat fraud but in their usual tactics seem to be not even addressing the problem but rather sweeping it under the rug.  The experts, the geniuses, the policy dolts (we would say policy wonks but CMS doesn’t seem to employ more than few intelligent public servants that could be counted on one hand), the morons, the bureaucrats in Baltimore and Washington seem to be sitting high upon their ivory towers looking down at all of the little people just waiting for their next authoritative decision.


While CMS is still throwing around this idea, anyone who is aware of the current home health environment knows that the prior authorizations will do nothing to curb fraud. The information available to CMS to target those agencies who continue to commit fraud is right in front of them but maybe being too politically correct is standing in their way.  With modern data analytics – we use the word modern loosely since it’s the government – data is available from claims to analyze, track and detect fraudulent patterns.


But instead of using their brains, CMS is using their power to create another layer of bureaucracy.  Rather than working efficiently and focusing their time on efficiency, they would rather create inefficiency and create a new department.  Your tax dollars at work –right before your own eyes.


In order to get the point across, and most agencies annoyance with this potential new rule, it’s time to let CMS know.  Write letters, send emails but also call.  Nothing is more annoying to those in power who think they know it all than the necessity to actually speak to one of their perceived inferior serfs.  Likely they may not answer, but call back and continue to call. After all, they do work for you – the tax payer and you do have a right to express your concern and option.  It is still a free country and the First Amendment has yet to be rescinded by Executive Order.


One has to really ask, with all of the money paid to national groups such as NAHC – how come nothing positive ever gets done for home health.  Why is that agencies continually get the short end of the stick while the president, vice presidents and directors all continue to earn six figure salaries of a non-profit advocacy group yet, the local agency continues to struggle?  Is the DC bubble that large and corrupt? The short answer is actually, yes.


If you look at the political donations of the leadership of NAHC you will see that it is tilted towards one side who ushered in the Affordable Care Act but didn’t have time to actually read what was in it until after it passed.  Use a simple political contributions search engine and put the names of some of the NAHC presidents and directors in…The results will make you wonder whose side they are really on and whether or not you membership is worth it.