Federal fraud fight shifts focus from DME to home health

Federal fraud investigators testified last week said they are shifting focus from durable medical equipment to home health while implementing more methods and systems to prevent fraud.

Speaking to a Senate Finance Committee on April 24, Daniel Levinson, inspector general of the Department of Health and Human Services, said that federal officials are now focusing largely on home care fraud in South Florida—an area once known for DME fraud. He noted a recent case involving ABC Home Health and Florida Home Health in which 50 people were convicted in connection with $25 million in fraudulent billing.

“The scheme involved kickbacks and bribes paid to patients, patient recruiters and doctors,’’ he testified.

Levinson said Medicare fraudsters tend to shift their schemes to various regions and sectors of health care. And fraudsters are focusing less upon DME because that sector has attracted so much attention from fraud fighters, and there are now better safeguards in place.

Dr. Peter Budetti, deputy director for the Center for Program Integrity at the Centers for Medicare & Medicaid Services, testified that CMS is shifting from “pay-and-chase” systems to new methods and technologies to identify fraud patterns early.

“The first is the new Fraud Prevention System (FPS) that enables CMS to use predictive analytic technology to identify aberrant and suspicious billing patterns in claims before payment is made; the second is the Automated Provider Screening (APS) system that is identifying ineligible providers or suppliers prior to enrollment or revalidation,’’ he testified.

AAHomecare noted that it has pushed for better anti-fraud action for several years, and many of its recommendations have been adopted. “The Association continues to work with Congress and CMS to enact measures that strengthen program integrity in Medicare and preserve access to home medical equipment and services,’’ the organization said in its newsletter last week.

Transcripts of testimony before the committee are available on the Senate website.

Meanwhile, CMS issued a final rule last week that requires stronger safeguards against fraudsters ordering and certifying medical services, supplies and services.

It is intended to ensure that only qualified, identifiable providers and suppliers may order or certify medical services, equipment and supplies. It will allow CMS to verify provider credentials, and connect specific claims to the person or company placing the order.