WASHINGTON — Home medical equipment stakeholders were outraged last week after their offers to be part of the solution to Medicare fraud were rebuffed and a national summit on health care fraud went on without industry input.
Held Jan. 28, the National Summit on Health Care Fraud was organized by the Department of Health and Human Services and Attorney General Eric Holder's office and included government officials, prosecutors and investigators, state law enforcement, private sector health care plans, consumers and providers other than those in HME.
Speakers included Holder, HHS Secretary Kathleen Sebelius and Acting Deputy Attorney General Gary Grindler, among others.
The summit is the latest initiative of HEAT (the Health Care Fraud Prevention & Enforcement Action Team), which, announced by Holder and Sebelius in May 2009, has expanded Medicare Fraud Strike Force operations from Miami and Los Angeles to Detroit; Houston; Brooklyn, N.Y.; Baton Rouge, La.; and Tampa, Fla.
The snub from both HHS and the Centers for Medicare and Medicaid Services prompted the American Association for Homecare and the VGM Group in Waterloo, Iowa, to voice their objections to members of Congress, saying their exclusion was an illustration of CMS' incompetence and should not be repeated in future meetings.
"We will make it clear in our conversations with the administration and with Congress that we expect to be at the table when these [future] discussions occur," said Michael Reinemer, vice president, communications and policy, for AAHomecare.
Reinemer said the association had asked as far back as November to be included in the strategy session, but was told "participants in the policy discussions would be strictly limited and would be focused on law enforcement."
That response did not explain, he said, why the HME sector would be excluded.
"To not invite the very people who can show where the fraud is is inexcusable," said John Gallagher, VGM vice president of government relations.
Gallagher said VGM's Fraud Eradication Advisory Team had also asked to be included in the summit. That request went unacknowledged.
"We have our hand out, saying, 'We'll work with you, show you where the fraud is, give you ideas on how the industry can help you with this,'" Gallagher said, adding: "The sad thing is, we shouldn't have to ask. They should have come to the industry and the stakeholders and said, 'How can we come together to fight this fraud?'"
The summit's intent, according to Holder's office, was to bring together "leaders from the public and private sectors to identify and discuss innovative ways to eliminate fraud, waste and abuse in the U.S. health care system."
If that was the intent, the HME advocates asked, then why was HME excluded?
Gallagher speculated that to include HME would have exposed "the incompetence of CMS and its contractors," which have proven largely ineffective in preventing fraudulent characters from getting provider numbers or even identifying fraudulent claims before millions of dollars have been paid out — despite the fact that some of those fraudulent providers have been reported by honest HME providers.
"The national 'summit' on health care fraud would have benefited from the perspectives and insights of the home medical equipment sector, which has been deeply concerned about Medicare fraud for decades, and we object to being left out of the discussions," said AAHomecare President Tyler Wilson.
During the summit, Sebelius singled out HME as an example of what CMS is doing regarding fraud.
"It used to be to be very appealing to criminals because it was relatively easy to set up a fake storefront. All you had to do was rent a room, put some equipment on the shelves, get a phone line and you were set," she said.
Within the last year, Sebelius said, "we've made it a lot harder for crooks to run this scam" by conducting more random site visits and requiring accreditation and surety bonds.
"The days when you could just hang a shingle and start billing Medicare are over," she said.
Holder noted that in 2009, the HEAT effort and other Justice Department actions brought more than 500 convictions for health care fraud and recovered $2.2 billion. But there's more to be done, he said.
"We cannot do it alone," he said. "We need help from state and local leaders and engagement from across the insurance industry and health care provider community."
Both the VGM and AAHomecare officials pointed out that the industry is eager to help combat fraud, but its offers to do so have so far not been accepted.
"The honest provider out there wants more than anything to get rid of the fraud because it is killing our business," said Gallagher. However, even providers' reported suspicions of fraud are often ignored, stakeholders have said.
"AAHomecare has proposed specific, concrete recommendations in an aggressive, 13-point anti-fraud action plan which, if adopted, could further reduce the potential for unqualified providers to be granted Medicare supplier numbers in the first place and subsequently reduce the potential for fraud," Wilson pointed out. (To view AAHomecare's fraud deterrent plan, go to www.aahomecare.org/stopfraud.)
Indeed, elements of AAHomecare's plan are included in the Prevent Health Care Fraud Act of 2009 (S.2128), which was introduced last year by Sen. George LeMieux, R-Fla. AAHomecare strongly supports the bill.
"At this point, there is only one Democratic senator [cosponsoring] this legislation, so we hope that number will increase," said Reinemer. "We believe the Obama administration will request higher funding for anti-fraud efforts in Medicare, which could help fund the LeMieux bill and the full 13-point plan that AAHomecare has proposed."
In his State of the Union address Jan. 27, President Obama called for expanding the crackdown on Medicare fraud and said he would seek an 80 percent increase in funding to do so.
With the strong emphasis in the administration and Congress on defeating health-care fraud and abuse, Gallagher said he expects more summit meetings. He hopes, he said, that they will be more than just "sitting around and having a group think."
"The question is," he said, "is it just whitewash again? If that's the case, we need to be out there picketing and saying, 'Why aren't we in there?' We need to take a more aggressive stance. We need to call foul when it's foul and go to our members of Congress and say, 'Here, here is continuing evidence of CMS' ineptness.'
"Getting one or two crooks is just skimming the top," he said. "They're a day late and billions of dollars short."