AAHomecare: Consider 13-Point Fraud Prevention Plan — Please!

WASHINGTON — Last week at a Senate subcommittee hearing on
Medicare and Medicaid fraud, AAHomecare submitted a statement for the record
outlining its 13-point plan to stop fraud.

But during the Wednesday hearing, an association update said,
the DMEPOS competitive
bidding program “was discussed as if it were an anti-fraud tool
and a panacea for Medicare reform.”

A CMS official presented the following testimony at the hearing,
which was conducted by the Senate Committee on Homeland Security
and Governmental Affairs Subcommittee on Federal Financial
Management, Government Information, Federal Services and
International Security:

“Until DME competitive bidding is fully operational, CMS is
pursuing a ‘stop-gap program’ to focus on Medicare fraud in seven
high-risk areas across the country where CMS is increasing our
oversight of the highest paid DMEPOS suppliers and the highest
billed DMEPOS equipment and supplies.

“The ‘stop-gap program’ increases pre-payment reviews of medical
equipment suppliers and will also single out the highest-billed
claims — continuous positive airway pressure (CPAP) devices,
oxygen equipment, glucose monitors and test strips and power
wheelchairs … The plan toughens the background checks on new
suppliers and increases scrutiny on the highest ordering physicians
and the highest utilizing beneficiaries.”

AAHomecare unveiled its 13-point plan to reduce fraud last fall,
but in the midst of the election, “it didn’t resonate the way it
should,” President Tyler Wilson said later. So the association held
a press briefing and presented the plan to Congress again in
February.

Among its provisions, the plan mandates site inspections and
requires a six-month trial period for new providers. The anti-fraud
plan also calls for stiffer quality standards, increased penalties
for fraud and real-time claims analysis to identify skewed billing
patterns more quickly. (See One More Time:
AAHomecare Rolls Out Anti-Fraud Plan, Feb. 11.)

Wilson told reporters the association’s action plan “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.”

In its statement to the subcommittee last week, the association
said the plan “is a tangible demonstration of the home medical
equipment sector’s commitment to stopping fraud and abuse in the
home care sector. More importantly, the plan will ensure that bad
actors will no longer manage to enter the system, and those that
are unfortunately already in are quickly discovered, removed and
harshly punished.”