ATLANTA--Amid its trumpeting of the need to squelch fraud and abuse in Medicare's DME sector, CMS has recently taken steps that some industry stakeholders see as contrary to the cause--namely, reappointing Palmetto GBA as the National Supplier Clearinghouse and dropping accreditation deadlines for round two of competitive bidding.
The American Association for Homecare has been vocal about the organization's stance on both Palmetto's continuing contract and the discarding of the accreditation dates. On each count, AAHomecare leadership says CMS is essentially shooting itself in the foot when it comes to preventing fraud and abuse.
“You have to wonder whether the focus on DME is designed to shift attention away from the failure of CMS to use its existing authority and tools at its disposal to ferret out and stop fraud against Medicare,” said AAHomecare President and CEO Tyler Wilson.
“CMS has just renewed its contract with Palmetto GBA, the private company that serves as the National Supplier Clearinghouse for Medicare. Palmetto serves as the gatekeeper for issuing and renewing DME Medicare billing privileges and is required to establish and maintain programs to prevent and detect fraud. The renewal raises the question, 'Why is a contractor that has failed miserably being rewarded with another contract?'”
In reference to mandatory accreditation, AAHomecare issued a statement declaring its opposition to the CMS decision to drop the round two deadlines: July 21, 2008, for providers who wished to submit bids; and Jan. 14, 2009, for those who wanted to be considered for contracts. (See HomeCare Monday, July 28.)
Reasoned Wilson, “Accreditation for this industry is 30 years overdue. If the federal government wants to get serious about preventing fraud and preventing theft of taxpayer dollars, it should use tools like accreditation more aggressively and use its ample, existing authority much more effectively.”
Some Republican senators are looking at the fraud issue on their own.
On Monday, the Senate Republican Conference held a hearing on Medicare fraud presided over by Sens. John Cornyn of Texas and Mel Martinez of Florida. While the hearing was designed to address Medicare fraud on all levels, AAHomecare's Michael Reinemer, vice president of communications and policy, said the meeting missed its mark.
“To their credit, the number of senators that spoke pointed out that Medicare fraud cuts across a wide spectrum of areas including physicians, labs, dentists, billing agencies--not just DME. And to his credit, [Iowa Sen. Charles] Grassley mentioned three or four reasons why competitive bidding was halted related to the exclusion of providers and all of the administrative snafus that occurred,” said Reinemer, who attended the hearing.
“However, the witnesses trotted out the same sorry litany of DME examples, even though by their own accounting, DME fraud represents less than 1 percent of the total [annual] Medicare fraud.
“This hearing should have focused on the real, significant causes of fraud. Instead, there were just some passing references to other areas [of fraud] but they spent an inordinate amount of time on wheelchairs and oxygen. It was way disproportionate to their own accounting of where the majority of the fraud is occurring,” Reinemer said.
According to government figures, Medicare loses approximately $70 billion annually to fraud. Of that, approximately $700 million--less than 1 percent--is from fraudulent DME claims.
The focus on DME, Reinemer said, is “absurd.”
“The DME fraud, while abhorrent, is like a pimple on an elephant. If it wasn't so tragic it would be comic that these guys spent so much time looking at the pimple and not the elephant,” he said.
Regarding CMS' recent actions, Joan Cross, director of operations at Bradenton, Fla.-based C&C Homecare and former president of the Florida Association of Medical Equipment Services (FAMES), said she approves of Palmetto's contract renewal and feels that the Sept. 30, 2009, mandatory accreditation deadline for all DMEPOS providers is acceptable.
“I liked CMS re-signing Palmetto,” said Cross, who serves as chairman of the industry's National Supplier Clearinghouse Advisory Council. “Better the devil you know ... They may not always be able to do something about [a problem], but they do take it back to CMS. They seem to be trying really hard to do a good job. It's hard. It's a big industry. We don't need any more changes.”
She went on to say that, while "accreditation is certainly closer to the answer for fraud than anything they've done thus far," she doesn't think elimination of the round two accreditation deadlines is a major concern.
“What difference does [it] make? Everyone has to be accredited by Sept. 30, 2009. That's only one year from now," Cross said, "so what's the big deal [with dropping the other dates]?”
All parties agree, however, that something must be done to combat Medicare fraud.
Reinemer said AAHomecare is making some progress with legislators.
“We are working with Sen. Cornyn and Sen. Martinez toward some common-sense solutions to preventing fraud. There are some constructive conversations … trying to ensure that anti-fraud initiatives are effective and aimed at the right areas,” Reinemer said.
He also said that a new bill--the Seniors and Taxpayers Obligation and Protection Act (S. 3164) introduced in June by Cornyn and Martinez--may yield some positive results.
The bill “is about helping to prevent fraud at the front end of the process,” Reinemer said. “It's designed to implement some screens at the front end before payment is made instead of the current system of 'pay and chase' where you pay and then try to track them down afterwards,” Reinemer said.
According to AAHomecare, the "STOP" bill would establish a system for unique identifiers of certain durable medical equipment, urge HHS to implement the DME surety bond requirement that was enacted in the Balanced Budget Act of 1997, require monthly verification of the accuracy of charges for physicians’ services, provide for a study of real-time data review and amend the Medicare enrollment application.
For a summary of the bill's provisions, see "STOP Act Aims to Curb Medicare Fraud" in this issue.