BALTIMORE — On Friday, new screening requirements for Medicare DME enrollees took effect, along with new application fees.
According to attorney Jeff Baird, chairman of the health care group at Brown & Fortunato, Amarillo, Texas, the new requirements are part of the government's move away from "pay-and-chase" to "guarding the henhouse" when it comes to fighting fraud.
"In the early days of the industry, it was easy for a company to obtain a Medicare Part B supplier number." Baird said. "The screening process was rudimentary."
A sham company could "easily" get a billing number, submit fraudulent claims and then "shut down and escape just ahead of the posse," Baird said. But with the government's growing focus on fraud, now a company "must jump through multiple hoops before it is awarded a supplier number."
Two of those hoops include purchasing a surety bond and becoming accredited, which by themselves have weeded out a lot of the crooks, Baird pointed out. As of March 25, newly enrolling DME company principals will also be subject to a criminal background check and fingerprinting at a future date.
Baird said HME providers are also experiencing unannounced site visits from a variety of sources, including the National Supplier Clearinghouse, the Office of Inspector General, state Medicaid, accrediting organizations and Medicare contractors.
"If a DME supplier is conducting a non-compliant, or perhaps a fraudulent, operation, there is a reasonable chance that the non-compliance/fraud will be discovered when a person walks unannounced onto the supplier's premises, eyeballs the operation and asks for evidence that the supplier standards are being followed," Baird said.
In addition to expecting an NSC site visit when it's time for reenrollment, he added, HME companies should expect unannounced site visits on a periodic basis. Last year, CMS issued final rules enhancing Medicare supplier standards for DME companies, including more stringent operations and facilities requirements.
For more from Baird on new screening and disclosure requirements under health reform, see "Screening and Disclosure," his "Law School" column in the March issue of HomeCare.