200 Miami HMEs Lose Provider Numbers

MIAMI–Some 200 HME providers in the Miami area have received
letters from the National Supplier Clearinghouse suspending their
provider numbers–and many, if not all, are without appropriate
cause, attorneys and providers said.

“As of right now, the numbers are revoked and [CMS is] not doing
claims,” said Neil Caesar of Greenville, S.C.-based Health Law
Center. “They also have put every claim [for those numbers] that
was in the pipeline on 100 percent audit.”

Those actions have not only crippled many providers’ businesses,
they have put beneficiaries at risk, said Javier Talamo of Kravitz
& Talamo, Hialeah, Fla. “The providers are going broke as
bureaucracy grinds to a halt. If you suspend 200 providers, you
risk thousands of patients having no providers.”

Talamo and Caesar said the letters, dated Dec. 18 and Dec. 20,
were sent out over the holiday season.

“In the letters, [the NSC] says they visited the suppliers
multiple times and the providers were not at their locations.
Therefore, they are in violation of all 21 standards,” said Talamo,
who has about 30 clients who have received such letters.

The Dec. 18 letters do not allow suppliers to put forth a
corrective action plan, Talamo said, while the letters dated Dec.
20 do.

Still, said Caesar, while those letters stated providers had 15
days before the provider number would be pulled (“even though the
manual says 30 days from the postmark”), the NSC didn’t wait 15
days from the date of the letter before suspending the numbers.

Neither of the letters says when the visits were made, Talamo
said. He added that providers did not find any notices posted on
their doors indicating a visit. Caesar said he doubts that any more
than a single visit was made, if that.

Talamo said that “Medicare may not have gone to some locations
and, without a doubt, did not go to all of them and did not go
multiple times. If that is proven to be true, it is scandalous. It
is a national scandal for NSC and Medicare.”

Another big problem is the erroneous charge against the
providers, the attorneys said. Both letters cite a single statute
that providers are said to have violated, but it is not applicable
to the HME industry, according to Caesar and Talamo.

“The statute–42CFR Section 405.535–refers to mammography
services,” said Talamo. “I have written Medicare directly and
spoken to their office and requested a rescission of the letter
based on two things: You have providers who are treated
differently, and the statute they use is indefensible. I cannot
have a hearing on mammography.”

As of Friday, Talamo said, he had not yet heard back from
CMS.

Caesar, who also represents clients who have received letters,
said he has gotten only “scripted answers” from CMS and the NSC.
While the rule has been around for years that CMS is to have a
hearing within a week for a provider in jeopardy of losing its
provider number, “they claimed they were swamped because of the
holidays,” Caesar said, and no hearings have been set.

“They are not even adhering to their own rules,” he said. “They
mishandled this, and in a way that seems totally indifferent to
following the rules.”

Talamo agreed. “If Medicare expects providers to follow the
rules, they should follow the rules.”

News of the rescinded provider numbers spread like wildfire
through the Florida HME community.

“Isn’t this the United States? We are supposed to be innocent
until proven guilty, and that’s not what is going on here,” said
Joan Cross, president of C&C Homecare in Bradenton, Fla. Cross,
current president of the NSC board and former president of the
Florida Association of Medical Equipment Suppliers, said most
providers could not afford to defend themselves against such
actions.

Raul Lopez, director of operations for Bayshore Dura Medical,
Miami Lakes, Fla., and current president of FAMES, said he is
concerned that in their zeal to derail fraudulent activities, CMS
is being too aggressive.

Lopez noted that one provider contacted FAMES when his company
was at risk of losing its provider number because its 21 standards
listed “HCFA,” the predecessor of CMS. But because the official CMS
document also said HCFA, the number was not rescinded.

“I would like to know how [the government is] going into these
companies. Are they being super aggressive? Are they allowing for
explanation?” Lopez asked. “I would hope that they are not being
super aggressive with things that are small or just clerical.”

For his part, Talamo warned that as goes Miami, so goes the rest
of the nation. “Just remember that these are the people that are
going to be running competitive bidding,” he said.

“This is Miami’s problem now, but if you are in [an MSA for
competitive bidding], it will soon be your problem as
well.”