AAHomecare Offers 13-Point Plan to Stop Medicare Fraud

ARLINGTON, Va. — The American Association for Homecare is
hoping 13 will be HME’s lucky number, at least when it comes to
healing the industry’s black eye from fraud and abuse.

On Friday, the association unveiled a 13-point plan it believes
could eliminate most of the Medicare fraud attributed to the HME
sector.

“The home care sector has zero tolerance for illegal activity,
and we are frustrated that the problem seems to be growing rather
than shrinking,” said Tyler J. Wilson, AAHomecare president and
CEO. “Taxpayer dollars lost to fraud represent theft of resources
needed by seniors and people with disabilities. So, we are sharing
these aggressive new recommendations with Medicare and its
contractors, Congress, the Department of Justice, and the FBI in
the hope that we can keep criminals away from the Medicare
program.”

AAHomecare’s 13 specific recommendations include:

• Mandating site inspections for all new HME providers. A July
  2008 GAO report underscored the need for CMS to ensure that its
  contractors are conducting effective site inspections for all new
  applicants for a Medicare supplier number.
• Requiring site inspections for all HME provider renewals. All
  renewal applications should require an in-person visit by the
  National Supplier Clearinghouse, the contractor CMS uses to ensure
  integrity in the Medicare program.
• Improving validation of new home care providers. Additional
  validation of new providers should be included in a comprehensive
  and effective application process for obtaining a Medicare supplier
  number.
• Requiring two additional random, unannounced site visits for
  all new providers. Two unannounced site visits should be conducted
  by NSC during the first year of operation for new HME
  providers.
• Requiring a six-month trial period for new providers. The NSC
  should issue a provisional, non-permanent supplier number to new
  suppliers for a six-month trial period. After six months of
  demonstrated compliance, the provider would receive a “regular”
  supplier number.
• Establishing an anti-fraud office at Medicare. CMS should
  establish an office with the sole mandate of coordinating detection
  and deterrence of fraud and improper payments across the Medicare
  and Medicaid programs.
• Ensuring proper federal funding for fraud prevention. Increase
  federal funding to ensure that NSC completes site inspection and
  other anti-fraud measures.
• Requiring post-payment audit reviews for all new providers.
  Medicare’s program safeguard contractors should conduct
  post-payment sample reviews for six months worth of claims
  submitted to Medicare by new providers.
• Conducting real-time claims analysis and a refocus on audit
  resources. Medicare must analyze billings of new and existing
  providers in real time to identify aberrant billing patterns more
  quickly.
• Ensuring all providers are qualified to offer the services they
  bill. A cross-check system within Medicare databases should ensure
  that homecare providers are qualified and accredited for the
  specific equipment and services for which they are billing.
• Establishing due process procedures for suppliers. CMS should
  develop written due process procedures for the Medicare supplier
  number process, including issuance, denial and revocation of the
  Medicare supplier number. The procedures must include, for example,
  an administrative appeals process and timelines.
• Increasing penalties and fines for fraud. Congress should
  establish more severe penalties for instances of buying or stealing
  beneficiaries’ Medicare numbers or physicians’ provider numbers
  that may be used to defraud the government.
• Establishing more rigorous quality standards. Ensure that all
  accrediting bodies are applying the same set of rigorous standards
  and degree of inspection to their clients.

Several anti-fraud measures the association suggested were
incorporated into the Seniors and Taxpayers Obligation Protection
(STOP) Act (S. 3164), a bill to reduce Medicare fraud that was
introduced earlier this year. (See HomeCare Monday, Aug. 4.)

In July, the Medicare Improvements for Patients and Providers
Act—the same law that delayed competitive
bidding—closed a loophole that would have allowed
non-accredited providers to serve beneficiaries, and CMS has
mandated a Sept. 30, 2009, accreditation deadline for HME providers
nationwide.