We Are the Good Guys

For at least 30 years, the HME industry has been at the forefront of stamping out Medicare fraud and abuse.

So it’s not just insulting, it’s infuriating when some policymakers paint the entire industry as being rife with fraud and abuse. (Surely no honest member of Congress wants to be branded with a bribery or corruption label just because of a few rotten apples in the halls of Congress.)

The few bad actors operating fly-by-night home care scams in Medicare are not a part of our community, which has been championing higher standards for decades. So, if or when the fraud issue comes up in discussions with policymakers, it’s worth providing some history and perspective.

Our industry’s continuing commitment to fighting fraud and abuse is a model of responsible action going back a long time. In 1987, our predecessor organization, NAMES, established a code of ethics to set a high standard of conduct for the industry. We created a code of conduct in 1990 to prescribe specific steps to ensure high standards. In 1992, we began working with the National Health Care Anti-Fraud Association.

We helped enact the Social Security Act Amendments of 1994, legislation to prevent fraud. In Senate testimony in 1995, we stated that “even one unscrupulous home medical equipment provider is one too many.” That testimony described 18 specific steps the industry had taken to prevent fraud and abuse.

The long list of actions we have taken to fight fraud continues up to the present day, and is ongoing. We must all remain vigilant about ferreting out and reporting fraud and abuse.

Also, we must remind policymakers that both the federal government and the industry play key roles in combating fraud, and those roles are most effective when there is a partnership rather than an adversarial relationship. Last month, the American Association for Homecare again stressed its zero tolerance for Medicare fraud and abuse in a statement to the House Ways and Means subcommittees on health and oversight. Our statement reminded Congress to avoid any overgeneralizations about the home care sector.

We also offered the subcommittees three suggestions for addressing fraud and abuse:

1. The guiding principle should be providing Medicare beneficiaries with medical equipment technology and therapies that are medically necessary and appropriate.
2. Medicare coverage, coding, reimbursement and documentation policies, as well as standards for quality, should be clear and unambiguous. In recent years, AAHomecare has worked with CMS and its contractors to revise coding for power wheelchair products to improve Medicare coding and coverage practices. The association also has embraced the federal quality standards and accreditation requirements for home medical equipment required by the Medicare Modernization Act of 2003, and has worked closely with CMS to develop sound quality standards. In fact, last year we recommended that CMS adopt standards that were far more stringent than what the agency adopted in its final standards issued in November 2006.
3. The Medicare program has numerous anti-fraud and abuse safeguards in place that must be more effectively enforced. Proper enforcement of the current 21 standards, along with the implementation of new quality standards and accreditation, will go a long way toward cracking down on criminal activity.

Medicare and its contractors have the ability to conduct on-site inspections to ascertain the provider’s compliance with the supplier standards. The National Supplier Clearinghouse is also required to conduct on-site inspections when it issues a new supplier number and every three years upon renewal. Shell companies that are out to defraud the Medicare program should not be able to pass these unannounced site inspections.

So, let’s start by pressing Medicare to better enforce policies on the books rather than devise new and even more onerous policies. As we stated to Congress last month, we strongly advocate for ethical and honest participation in Medicare and also for clear, up-to-date, fair regulation that targets fraud and abuse but does not burden providers who follow the rules.

Tyler J. Wilson is president and CEO of the American Association for Homecare, Alexandria, Va. He may be reached by e-mail at [email protected]. For more information about the association, visit www.aahomecare.org.