One More Time: AAHomecare Rolls Out Anti-Fraud Plan

ARLINGTON, Va. — At a Tuesday press conference with
national media, the American Association for Homecare said it would put
its 13-point anti-fraud plan before Congress — again.

Unveiled in October in the middle of the election, the plan
didn’t “resonate the way it should,” AAHomecare President Tyler
Wilson told reporters. So the association is rolling it out again
to make sure Congress gets the message.

Among the provisions detailed in the legislative proposal are
more rigorous quality standards, increased penalties for fraud,
mandated site inspections for new providers and real-time claims
analysis (see “AAHomecare Offers 13-Point Plan to Stop Medicare
Fraud,” HomeCare Monday, Oct. 27, 2008).

Although providers are currently fighting numerous issues
including the 36-month oxygen cap and competitive bidding, Wilson
said concerns about fraud and abuse must “pillar all other
conversations.”

“There’s a lot going on. We face a lot of challenges,” he
acknowledged. “But just picking and choosing certain battles is not
a luxury the industry has at this point.”

Wilson pointed out that Medicare’s DMEPOS bidding program is a
price-setting mechanism and should not be confused with anti-fraud
measures.

“The problem stems from the fact that CMS’ efforts on the
fraud-and-abuse front have been too anemic for too long,” he said.
“Obviously [this is] a strong industry and there are a lot of
hardworking people, but time and again these stories break about
fraud and abuse. Clearly, [CMS has] to focus their efforts.
Curtailing abuse could let money go into other resources. Whatever
they have been doing, it has been too little for too long, so their
efforts need to be reinforced, and that’s what the heart of these
recommendations will do. “

Wilson said the association’s action plan “is a tangible
demonstration of or commitment to stopping fraud and abuse in the
system, and it is a proactive solution that will be far more
effective than unnecessary Medicare cuts to the home medical
equipment sector that only harm patients and seniors.”

Industry advocates in Washington today for AAHomecare’s
“Homecare on Capitol Hill” lobbying effort would carry the plan to
meetings with federal legislators on HME issues, he said.