WASHINGTON — Last week at a Senate subcommittee hearing on Medicare and Medicaid fraud, AAHomecare submitted a statement for the record outlining its 13-point plan to stop fraud.
But during the Wednesday hearing, an association update said, the DMEPOS competitive bidding program "was discussed as if it were an anti-fraud tool and a panacea for Medicare reform."
A CMS official presented the following testimony at the hearing, which was conducted by the Senate Committee on Homeland Security and Governmental Affairs Subcommittee on Federal Financial Management, Government Information, Federal Services and International Security:
"Until DME competitive bidding is fully operational, CMS is pursuing a 'stop-gap program' to focus on Medicare fraud in seven high-risk areas across the country where CMS is increasing our oversight of the highest paid DMEPOS suppliers and the highest billed DMEPOS equipment and supplies.
"The 'stop-gap program' increases pre-payment reviews of medical equipment suppliers and will also single out the highest-billed claims — continuous positive airway pressure (CPAP) devices, oxygen equipment, glucose monitors and test strips and power wheelchairs … The plan toughens the background checks on new suppliers and increases scrutiny on the highest ordering physicians and the highest utilizing beneficiaries."
AAHomecare unveiled its 13-point plan to reduce fraud last fall, but in the midst of the election, "it didn't resonate the way it should," President Tyler Wilson said later. So the association held a press briefing and presented the plan to Congress again in February.
Among its provisions, the plan mandates site inspections and requires a six-month trial period for new providers. The anti-fraud plan also calls for stiffer quality standards, increased penalties for fraud and real-time claims analysis to identify skewed billing patterns more quickly. (See One More Time: AAHomecare Rolls Out Anti-Fraud Plan, Feb. 11.)
Wilson told reporters the association's action plan "is a proactive solution that will be far more effective than unnecessary Medicare cuts to the home medical equipment sector that only harm patients and seniors."
In its statement to the subcommittee last week, the association said the plan "is a tangible demonstration of the home medical equipment sector's commitment to stopping fraud and abuse in the home care sector. More importantly, the plan will ensure that bad actors will no longer manage to enter the system, and those that are unfortunately already in are quickly discovered, removed and harshly punished."
