Accreditation Mandatory for Providers in Medicare Fraud Demo

ATLANTA--HME providers in Southern California and South Florida will be required to become accredited within a 90-day period under a stipulation in the massive anti-fraud demonstration to be implemented in those areas by CMS.

Providers who do not become accredited within that time after receiving notification from the National Supplier Clearinghouse to do so will lose their Medicare billing numbers, according to details of the initiative.

The requirement has stirred up industry stakeholders, who protested that it is an unreasonable standard.

"You can't get accredited in 90 days," said Miriam Lieber of Lieber Consulting in Sherman Oaks, Calif. "You have to have four months of records; you can barely get the surveyors out [in that period of time] ... This is just not feasible."

"I don't think it can be done in 90 days," agreed Mary Ellen Conway, president of Capital Healthcare Group, Bethesda, Md. "There is such a thing as a provisional accreditation for new companies, but not for existing companies. It's shocking to think that the NSC thinks this can be done in 90 days."

Under CMS' two-year initiative, which is designed to prevent deceptive home care companies from operating in the greater Los Angeles and Miami areas, about 7,700 providers will be required to reapply for their Medicare billing numbers within 30 days of receiving a notice from CMS to re-enroll. (See HomeCare Monday, July 9.)

Those that remain in the system will be subject to "intense review," CMS officials said when they announced the project on July 2. That process will include multiple unannounced site visits by NSC investigators, as well as a "fraud level indicator" for each provider that considers such factors as:

--Experience as a DMEPOS supplier with other payers;
--Prior Medicare experience;
--Specific supplier location;
--Fraud potential of products and services listed;
--Site visit results;
--Inventory observed and contracted; and
--Accreditation of the supplier.

Revocation of billing privileges will occur if "the DMEPOS supplier failed to obtain accreditation from an approved DMEPOS accrediting organization within 90 days of notification from the NSC to do so," according to the demonstration rules.