Anti-Fraud Bill Gets Companion as Reform Debate Continues

WASHINGTON — Almost a dozen senators have signed on as
cosponsors to S. 2128 — the “Prevent Health Care Fraud Act of
2009” — a bill designed to improve resources to prevent
Medicare fraud introduced by Sen. George LeMieux, R-Fla., in late
November. Last week in the House, Rep. Ginny Brown-Waite, R-Fla.,
introduced a companion bill, H.R. 4222.

The bill contains several provisions that the American
Association for Homecare outlined in its 13-point anti-fraud action
plan, which the association proposed to
Congress in February. Relevant provisions include real-time
audits and screens to catch fraudulent claims, more site
inspections to ensure that Medicare allows only legitimate HME
providers to file for reimbursement and a dedicated office at the
federal level to combat Medicare fraud.

AAHomecare has also recommended more money for federal
fraud-fighters. AAHomecare’s full 13-point plan can be viewed at
www.aahomecare.org/stopfraud.

Michael Reinemer, vice president of communications and policy
for AAHomecare, said it is unlikely these measures would be
considered as stand-alone bills, but he believes there may be
several opportunities in the 111th Congress to attach anti-fraud
provisions to larger health care legislation.

Wayne Grau, vice president, supplier relations and government
affairs for The MED Group, Lubbock, Texas, said members of his
organization, and countless other providers, want fraud removed
from Medicare so they can concentrate on taking care of
patients.

“You would think that with all of the talk about removing fraud
out of Medicare that [S. 2128] would garner more support from
senators, and could be passed as a stand-alone provision,” said
Grau. “The reality is that most likely this legislation will be
included in a larger health care package in the future.”

Longtime industry advocate Tom Ryan pointed out that those
broader health care packages on the table have several troublesome
provisions relating to HME, including elimination of the
first-month purchase option for power wheelchairs, expanding
competitive bidding in
Round 2 from 70 to 91 MSAs and mandating that competitive bid rates
be applied nationwide by 2016. (For more on power chairs, see “One
Step Forward on Rehab Benefit, One Step Back on First-Month
Purchase Option” in this issue.)

“There is also the manufacturers’ excise tax, the productivity
adjustment for noncompetitive bid items that would lower CPI,
elimination of the 2 percent add-on in 2014 for competitive bid
items, as well as the GAO study to determine the feasibility of
manufacturers bidding direct,” added Ryan, president and CEO of
Homecare Concepts, Farmingdale, N.Y. “Add to this the potential
hits to Medicare Advantage that will put pressure on them to make
up for this hit — very likely squeezing providers. I am not
feeling like a winner here.”