AAHomecare: Zero Tolerance for Fraud and Abuse

WASHINGTON–On Thursday, members of the House Ways and Means
Health and Oversight subcommittee convened a Medicare program
integrity hearing to ask law enforcement officials what tools they
needed to ramp up the fight against fraud and abuse in the
system.

While some, like R. Alexander Acosta, U.S. Attorney for the
Southern District of Florida, said more funding would be helpful,
HHS Inspector General Daniel Levinson said the OIG was adequately
funded and recovered $13 for every dollar spent.

Questions from subcommittee members also centered on whether
stiffer laws were needed for criminal prosecution of suspected
fraud, an idea some agreed merited further consideration.

The American Association for Homecare also weighed in with a
statement, stressing “zero tolerance for Medicare fraud and abuse
of any kind.”

The association cautioned against “any overgeneralizations about
the home care sector” and championed more effective enforcement of
the safeguards against fraud and abuse that Medicare currently has
in place.

The association offered several suggestions for curbing fraud
and abuse:

–First, the guiding principle should be to provide Medicare
beneficiaries with medical equipment technology and therapies that
are medically necessary and appropriate to give the patient a
fuller, more satisfying and healthier life.

–Second, Medicare coverage, coding, reimbursement and
documentation policies as well as standards for quality, should be
clear and unambiguous. In recent years, for instance, AAHomecare
has worked with CMS and its contractors to revise coding for power
wheelchair products to improve Medicare coding and coverage
practices.

The Association also has embraced the federal quality standards
and accreditation requirements for home medical equipment required
by the Medicare Modernization Act of 2003 (MMA) and has worked
closely with CMS to develop sound quality standards. In fact, last
year we recommended that CMS adopt standards that were far more
stringent than what the agency adopted in its final standards
issued in November 2006. Many of the requirements from the MMA are
only now nearing implementation.

–Third, the Medicare program has numerous anti-fraud and abuse
safeguards in place that must be more effectively enforced.
Currently, the Medicare program requires that suppliers adhere to
21 specific supplier standards (42 CFR 424.57) in order to obtain
and maintain billing privileges.

“We believe that proper enforcement of the current 21 standards
along with new quality standards and accreditation will go a long
way toward cracking down on criminal activity,” the association
said.