GAO Recommends Clarification of Medicare Supplier Standards

Washington

Fraudulent DME suppliers should not be able to enter the Medicare business in the first place, and vague supplier standards are partly to blame. So said the General Accounting Office’s (GAO) Leslie Aronovitz, director of health care program administration and integrity issues, in testimony at a late April Senate Finance Committee hearing on power wheelchair fraud and abuse.

“The standards NSC uses to evaluate suppliers are not explicit,” Aronovitz said. “Officials at CMS and NSC told us that some of Medicare’s supplier standards lack specificity as criteria for NSC to use in determining the legitimacy of a supplier.”

For example, Standard No. 4 requires that a supplier “fills orders, fabricates, or fits items from its own inventory or by contracting with other companies for the purchase of items necessary to fill the order,” but does not specify what defines a reasonable amount or type of inventory, Aronovitz explained.

Standard No. 7, regarding maintaining a physical facility on an appropriate site, also presents some issues because it does not adequately define “appropriate site,” Sheila Avruch, an assistant director at the GAO, told HomeCare, adding that the standard is not specific enough to rule out providers who might operate out of subdivided cubicles in a large office building.

“There is definite interest in the NSC to correct some of the problems,” Avruch added, “and [the NSC is] having some discussion with CMS about that.”

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