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,
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
"To not invite the very people who can show where the fraud is
is inexcusable," said John Gallagher, VGM vice president of
Gallagher said VGM's Fraud Eradication Advisory Team had also
asked to be included in the summit. That request went
"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
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
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,
"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."