An Open Letter to Congress

Earlier this year, the American Association for Homecare provided some specific recommendations to Congress for curbing fraud and abuse by criminals posing as legitimate home care providers.

The sad fact is that in some quarters in Washington, tales of a tiny percentage of home medical equipment fraudsters wag the entire dog when it comes to home care policy.

The broad brush that some congressional and administration officials use to stain the entire industry blurs the immediate, critical threats to home care — efforts to cut oxygen rates and the flawed competitive bidding process, which affects providers of rehab and assistive technology, medical supplies, respiratory devices, oxygen therapy and other HME categories.

To set the record straight, the association issued an open letter to Congress. It ran as an advertisement in Roll Call, the Capitol Hill newspaper, on June 20. The text from the letter, titled “Greater Efforts Needed by Medicare to Combat Fraud,” follows:

The American Association for Homecare, which represents home medical equipment providers and manufacturers, for years has been a staunch proponent of more stringent standards for participation in the Medicare Part B program for Durable Medical Equipment, Prosthetics, Orthotics and Supplies.

While our call for tighter controls over the years has gone largely unheeded, we applaud the federal government’s recent efforts to crack down on Medicare fraud. Ending improper Medicare billing and other fraudulent activity is a win all the way around.

It’s good for taxpayers, it’s good for Medicare beneficiaries, and it’s good for the members of the American Association for Homecare — honest, law-abiding and well-meaning companies in a critical health care sector.

The Association has urged the Centers for Medicare and Medicaid Services to require mandatory accreditation for all providers, which has been considered a minimum standard by private insurers since the 1980s. Congress finally enacted accreditation and quality standards in the Medicare Modernization Act of 2003, and those provisions are being implemented beginning this year. For the record, the Association recommended to CMS a higher set of quality standards than what the agency finally adopted.

The federal government must still do a better job of stemming fraud and abuse. Medicare and its private contractors have failed to shoulder the proper responsibility to effectively exercise their already-existing authority to combat fraudulent activity. They must insist on standards and other up-front controls that will deny illegitimate operators any chance of taking advantage of Medicare. Facility accreditation and tightened restrictions on entities that are allowed to obtain billing privileges will go a long way toward establishing an environment where unscrupulous companies cannot operate.

Congress must review Medicare’s existing processes for approving new durable medical equipment providers and auditing them after their supplier numbers are granted by CMS. Medicare’s Program Integrity Unit and Program Safeguard Contractors already have tools at their disposal to inspect, monitor, and audit such providers. It is clear that such systems failed in Miami, where a number of fraudulent operations were recently shut down.

Home care providers need clear, up-to-date, and fair federal regulations that effectively target fraud and abuse but at the same time do not unduly burden those companies that make every effort to follow the rules. The home care industry will continue its 30-year history of working with CMS and Congress to prevent fraudulent activity by criminals posing as legitimate home care providers.

Home care is cost-effective, clinically sound and preferred by patients. It is part of the solution to the challenge of vexing growth in health care expenditures. Let’s work together to make sure that home care companies can continue to deliver value to taxpayers as they provide medical equipment and therapies to the millions of older and disabled Americans who depend on them.

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.