Industry Leaders Urge Caution as CMS Loosens Reins

BIRMINGHAM, Ala. (April 8, 2020)—The COVID-19 pandemic has shown a spotlight on the importance that home medical equipment (HME) providers play in delivering care to patients in their homes. By allowing patients to remain in their homes, HME providers are freeing up hospital beds for COVID-19 patients and other patients with similarly serious health problems. In response to the unprecedented need to keep patients at home and avoid hospital overflow issues, government agencies and other payers are relaxing many of the requirements normally in place to ensure that payers only pay for HME items and services that are appropriate for the patient’s conditions.

Despite the relaxation of many of the coverage, documentation, testing, and other requirements, it is important for the HME provider community to be responsible and credible components of the health care system, said AAHomecare in a press release. The goals of the rule relaxation are (i) to ensure that patients with real medical needs can access the appropriate respiratory medical equipment in their homes, (ii) to minimize the spread of COVID-19, and (iii) to free up hospital beds to those who truly need them. Sensational and aggressive marketing tactics may be fraudulent and abusive. They are certainly unethical and inappropriate and will significantly damage the progress the HME community has made with policymakers in recent years.

In the press release, AAHomecare suggested that even though the coverage and other Medicare criteria have been relaxed, HME providers should exercise their best judgment in following the new guidance. CMS has made these changes to (i) help the HME community provide exceptional care in challenging conditions, (ii) help alleviate the extraordinary burden many hospitals are facing, and (iii) reduce the risk of exposure to the COVID-19 virus for both patients and HME professionals. HME providers should continue to ensure that their patient care and business practices during this pandemic adhere to both the (i) “letter of the law” under the relaxed regulations and (ii) the “spirit of the law” (i.e., the reasons this regulatory relief has been granted).

“Unfortunately, the HME industry has been prone to having a few bad apples spoiling the bunch,” said Wayne Wayne H. van Halem president of The van Halem Group in a statement. “We must remain vigilant. We are being given an enormous opportunity by CMS at this moment. An opportunity to shine, provide tremendous value, and help save lives during this pandemic, which could forever change the image of our industry with policy-makers for the future.”

Federal and state laws prohibiting kickbacks, inducements, false claims and other fraudulent and abusive behavior remain intact. HME providers should ensure that their communications with referral sources and patients do not run afoul of these laws.

It is critical that HME providers not use the relaxed requirements to engage in fraudulent and/or unethical acts designed solely to generate revenue. We are all in this together, and there is no room for any type of questionable behavior. AAHomecare urges the HME community to police itself and report any suspect behavior to the National Center for Disaster Fraud Hotline: (866) 720-5721 or [email protected].

VGM & Associates has created a website for providers to report suspected fraudulent activity and abuse of the Medicare program.