Those of us at the Florida Association of Medical Equipment Suppliers were feeling rather proud of ourselves. We had the audacity to sue the State of Florida over competitive bidding for Medicaid DME and actually won!
However, our good feeling didn't last long — competitive bidding is back in Florida, introduced this time as a “pilot program” in state budget proviso language. This competitive bidding program is actually worse than the last one because it has a capitation portion that allows only one provider in the chosen “pilot” area.
When we found out about the new program, the FAMES board members got busy and contacted our state senators only to find out that this program was proposed, once again, in response to fraud and abuse in the Florida Medicaid program.
It's disheartening to find out that our industry is not known for the good it does but only the improper conduct of a few dishonest individuals. To further compound the inequity, legislators in every state congressional office that I visited asked what our industry was planning to do to address this issue.
With financial cutbacks occurring in all areas of health care, fraud and abuse has come to the forefront in talks about eliminating waste in Medicaid and Medicare programs. In addition, any time CMS wants Congress to support cuts to our industry, all they have to do is wave the fraud and abuse banner to gain immediate support for whatever initiative they deem necessary.
Unfortunately, all providers are being blamed for this industry's costs to the health care system. The latest “Wheeler Dealer” initiative is a perfect example of all providers being punished for the deeds of a few. CMS calls the fraud and abuse that prompted Operation Wheeler Dealer the “improper hemorrhaging of Medicare dollars.” We all know that this refers to a select few providers who want to make a lot of money with little effort, and then move on to gouge another area of our industry or another industry altogether, only to be replaced by someone else who will repeat the process. As a result, our industry will probably continue to be penalized until the plundering committed by these modern day pirates is under control.
So now the question is: What can this industry do to combat fraud and abuse? The obvious initial step seems to be implementing mandatory state licensure for providers. Only 17 states currently have state licensure laws. Ohio has been pushing a licensure bill for several years now and has met with resistance every step of the way.
This makes absolutely no sense to me. State licensure is critical, not just in Ohio, but in every state, for three very simple reasons: 1) State licensure lends professional credence and respectability to this industry; 2) State licensure assures the public that a dealer provides quality and consistent care; and 3) State licensure protects the viability of state and federally funded programs. I understand that state licensure is not the answer to all of our problems, but it is a step in the right direction.
What else can we do to fight fraud and abuse? Those caught and found guilty of actual fraud must feel the sting of that wrongful act. There must be teeth put into any laws that address this issue.
It is one thing to make an error and bill incorrectly. However, there is no justification for someone to establish a program designed to defraud the government intentionally and leave the rest of us to take the heat. These wrongdoers should be prosecuted to the fullest extent of the law, and their punishment should include heavy fines, incarceration and expulsion from the Medicare and Medicaid systems.