Industry Reacts Swiftly to Strike Force Release

ATLANTA–As a press release about the Medicare Fraud Strike
Force was picked up last week by news organizations including
The Associated Press and the Washington Post,
industry stakeholders reacted swiftly, arguing that legitmate
providers are unfairly associated with such activities. (See story
above.)

They say federal officials haven’t done everything they can to
root out fraud.

In a story on its Web site about the release, the VGM Group
noted that its new fraud and abuse reporting Web site had received
more than 250 visits since its launch last month and quoted CEO Van
G. Miller as saying, “At VGM, we’re sick and tired of those
nameless bureaucrats and publicity seeking politicians who seek to
tar and feather our entire industry because of the actions of a
few.”

Miller continued, “That’s why I’ve sent letters and e-mails to
all VGM Group members and several thousand non-VGM organizations
that service Medicare beneficiaries. VGM is acting as a central
point of communication for any HME provider–member or not–who
wishes to report fraud.”

Officials at the American Association for Homecare said they had
issued a response to the Washington Post and also planned
to send the following statement to press and congressional offices
today:

American Association for Homecare Says Medicare and Its
Contractors Have Failed to Combat Medicare Fraud Effectively
ARLINGTON, Va.–The American Association for Homecare restated
today that the home care industry, which provides medical equipment
and therapies in the home, supports stepped-up efforts to crack
down on Medicare fraud and looks forward to continuing work with
federal agencies and Congress to prevent fraudulent activity. At
the same time, the Association said Medicare has failed to
effectively exercise its already ample authority to combat fraud
and abuse.

“Medicare and its private sector contractors must vastly improve
their approach and do a better job at insisting on standards and
other up-front controls that will deny illegitimate operators any
chance of taking advantage of the Medicare program,” stated Tyler
J. Wilson, president and CEO of the American Association for
Homecare. “Accreditation and tightened restrictions on entities
that are allowed to obtain billing privileges will go a long way
toward establishing an environment where unscrupulous companies
cannot operate.”

“We have been at the forefront of efforts to prevent fraud,
which is why the home care industry supports accreditation, quality
standards, and other steps to help stem illegal activity. Medicare
has failed to impose up-front measures that will curb the
opportunity for fly-by-night operators to rip off Medicare,” Wilson
said. “Existing regulations give Medicare ample authority and tools
to address the issue. The American Association for Homecare
strongly advocates for ethical participation in Medicare and also
for clear, up-to-date, and fair federal regulations that target
fraud and abuse but that do not unduly burden those providers who
make every effort to follow the rules.”

The Association says the vast majority of home care companies
are owned and operated by law-abiding individuals. In many cases,
these firms are family operations involving multiple generations,
who are dedicated to providing the best possible therapies and
medical equipment to treat and improve medical conditions for
patients at fair prices. Home care providers serve patients who
suffer from a variety of conditions ranging from multiple sclerosis
and congestive heart disease to chronic obstructive pulmonary
disease (COPD).

Earlier this year, the American Association for Homecare offered
suggestions to congressional committees for addressing fraud and
abuse:

–First, the Association has endorsed 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 along the way to develop those quality
standards. In fact, last year the Association 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.
Medicare coverage, coding, reimbursement and documentation policies
as well as standards for quality, should be clear and
unambiguous.

–Second, 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
specific standards in order to obtain and maintain billing
privileges. Proper enforcement of the current rules along with new
quality standards and accreditation will go a long way toward
cracking down on criminal activity. For example, Medicare and its
contractors currently have the ability to conduct on-site
inspections to ascertain the provider’s compliance with the
supplier standards. The National Supplier Clearinghouse (NSC) is
also required to conduct on-site inspections when it issues a new
supplier number and every three years upon renewal. Shell companies
that are purposefully out to defraud the Medicare program should
not be able to pass these unannounced site inspections.

Home medical equipment is a critically important benefit that
serves millions of beneficiaries. [HHS] Secretary Michael Leavitt
has called for greater use of home- and community-based care in
Medicaid because “it’s not only where people want to be served, but
it’s radically more efficient.”