Fraud Dj Boo-Boo

Remember Operation Wheeler Dealer? Remember the doctor who wrote thousands of power wheelchair scrips? Remember the special CMS task force that, for a time after launch of the massive fraud investigation, had to approve every single Houston-area PWC claim?

Remember how local providers said they had reported fraudulent companies for years before the government caught up?

Unfortunately, it looks like history is repeating itself, this time in South Florida, which one official has labeled “ground zero” for Medicare fraud in the United States.

After years of rumor about a whopping number of sham companies, the government has come down full force on DME fraud in the area. A Medicare Fraud Strike Force was formed after the OIG found that of 1,581 unannounced site visits, 31 percent of the companies in Miami-Dade, Palm Beach and Broward counties didn’t even have a location at the address they had given to Medicare.

In its initial sweep, the multi-agency team — comprised of federal prosecutors, FBI and OIG agents and personnel from local law enforcement — made 38 arrests and uncovered $142 million in schemes against Medicare. A second strike netted 16 arrests and another $101 million from false claims, bogus prescriptions, kickback violations and money-laundering.

Of course the situation is scandalous, both the fraud itself and the lack of oversight that should have caught it earlier.

For more than a decade, industry groups including AAHomecare and VGM have begged the government to do something about the situation, recommending all sorts of remedies including tougher standards for providers. Now those have come along with mandatory accreditation, and it looks like the government is paying attention to the fraud that must be cleaned up.

Washington critics, however, say the timing of such fraud initiatives is by design. Wheeler-Dealer was unveiled shortly before the Medicare Modernization Act was passed and, by some insider accounts, was one reason the law’s competitive bidding mandate made it through Congress. Now, just as the industry begins a full press for the Tanner-Hobson bill to undo some of the harsh provisions in the competitive bidding final rule, another big fraud push is on.

Whatever the truth, the issue is being addressed. The bad thing is that the sensational headlines about Medicare fraud are what the nation — including Congress — remembers, not the good work done by the vast majority of this industry’s honest providers.

Here’s your chance to help correct the image. Instead of being tarred with the same brush as those fraudulent operators, call your congressman. Invite him to your company, Tell him about your operation. Ask him to ride with you on a delivery route. Show him how hard you work and the good service you provide to your patients.

Fraud in any industry is a frustrating thing, and DME is by no means the only sector of health care it affects. A case recently crossed my desk involving fraudulent claims for brain surgeries.

But the current stories about DME give you a real opportunity to establish a relationship with your legislators. Let them hear how you feel about the crooks — and about competitive bidding. If you pass this one up, knowing the uncertain future you face when bidding kicks in, you may have to put it down as one of your last mistakes.