Enough Is Enough

Medicare fraud hurts beneficiaries by stealing resources. It hurts taxpayers whose dollars are wasted. And it hurts all of the law-abiding and well-intentioned HME professionals who carefully comply with the multitude of Medicare regulations and yet continue to provide high-quality services, supplies and equipment in spite of declining reimbursement.

That’s why AAHomecare is working hard to stop fraud and protect the reputation of the home care community. For years, many in the home care sector have insisted on tougher up-front controls and screening mechanisms — such as mandatory accreditation — that will prevent criminals from infiltrating the Medicare program and tarnishing the good name of providers.

Only recently have government watchdog agencies pinpointed the depth of this program, which validates our long-held belief that CMS and its contractors have been slow and ineffective in deterring fraud.

The tide is turning, but too slowly. CMS will require mandatory accreditation by September 2009, decades after the association began calling for accreditation and five years after Congress instructed CMS to implement the policy.

CMS recently delayed the January 2009 accreditation deadline for HME providers in the 70 areas designated for round two of competitive bidding, a move that we publicly opposed.

We also opposed exempting physical therapists, occupational therapists, clinical social workers and physician assistants, among others, from the DMEPOS accreditation requirements. This means that of the 113,000 active Medicare supplier numbers that are allowed to bill for HME, only HME providers must become accredited. Our estimate is that about 70,000 entities with supplier numbers will not be required to become accredited.

This exemption policy is not the way to preserve quality of care for patients. We should level the playing field for everyone who provides home medical equipment, and no one should get a free pass. So the responsibility falls on us to work in Washington to ensure that effective fraud prevention and early detection measures are established and enforced.

Congress strengthened the anti-fraud measures for the HME sector in the recently enacted Medicare Improvements for Patients and Providers Act by establishing the firm September 2009 deadline for accreditation and by closing a loophole that would have allowed unaccredited providers to serve Medicare patients.

Congress has held hearings on the topic, and several senators recently introduced the Seniors and Taxpayers Obligation Protection Act (STOP Act) to combat fraud. AAHomecare has proposed fraud-prevention measures to key members of Congress, and some of those provisions are reflected in the STOP Act. Our proposal would require:

• In-person scrutiny of all new and renewed applications of Medicare providers through a site visit by the National Supplier Clearinghouse, and random, unannounced site visits to all newly approved providers;
• Verification through the NSC by carriers to ensure that the supplier numbers are valid and that the HME practice is qualified to provide the services;
• Increased real-time monitoring of new providers’ claims and clinician ordering practices; and
• Postpayment reviews by CMS contractors to ensure the accuracy of claims filed by new providers.

It’s essential to stop Medicare fraud. But it is also important for policymakers and the media to refrain from tarnishing the entire home care sector when the real target is the small proportion of criminals who have been allowed to abuse Medicare. For that reason, we have established an anti-fraud task force to recommend additional, specific steps Congress must take to prevent fraud.

We are ramping up the fight against fraud. This is also a fight to preserve the HME sector, which is part of the answer to the Medicare crisis. We invite everyone to take part in this campaign. The health of our patients and the future of home care are at stake.

Tyler J. Wilson is president and CEO of the American Association for Homecare, headquartered in Arlington, Va. He may be reached at [email protected]. For more information on critical home care issues, visit the association’s Web site at www.aahomecare.org.