WASHINGTON--Blaming limited resources, a CMS official admitted on a National Public Radio piece airing last week that the agency has not been on the lookout for fraud--for years.
"In the past, perhaps we have not been as vigilant as we could have been," Kimberly Brandt, head of program integrity for Medicare, told NPR reporter Greg Allen.
Brandt's admission was, for industry stakeholders, one of the highlights of Allen's Nov. 6 report, which was a follow-up to his controversial piece on the home care industry and Medicare fraud that aired Oct. 11 (see HomeCare Monday, Oct. 22). Stakeholders lambasted that report as being one-sided and maligning all providers as "crooks." In an angry blitz of e-mails and phone calls to Allen, they called on the reporter to tell their side of the story.
On Tuesday, he did--and stakeholders were mollified, at least to some degree.
"The follow-up piece ... corrected two major problems in the first story," said Michael Reinemer, vice president, communications and policy for the American Association for Homecare. "In the follow-up, the reporter spoke with a real HME provider in the Miami area and he looked at the role of CMS in preventing fraud in the first place."
For the second story, Allen spoke with Raul Lopez, director of operations for Bayshore Dura Medical in Miami Lakes, Fla., and former president of the Florida Association of Medical Equipment Services.
"He spent about two hours with me," Lopez said, adding that he took Allen on a tour of his company's 14,000-square-foot facility and tried to give the reporter a true sense of the HME industry and the problems it faces. Lopez told Allen that the industry itself has raised numerous red flags over the years in attempts to get CMS to act on fraudulent activities, but to no avail.
"We have been screaming about this for far longer than CMS is willing to admit," Lopez said, noting that he was pleased Allen talked with a CMS official and addressed the issue in his Nov. 6 piece.
"Finally, Kimberly Brandt admits that [CMS] didn't do anything about it. They didn't actually look for fraud, and it's been going on for 10, 15, 20 years," Lopez said.
The South Florida provider said Allen's second piece showed that "there are legitimate providers who are trying to get rid of fraud ... It put a more positive light on our plight."
Reinemer called the CMS admission "a step forward" for the industry. However, he noted, "we still object to the notion that the home care business is 'rife with fraud,' which is an exaggeration. There is more that could have been said about the cost-effectiveness of home care, but that wasn't the focus of this particular story."
Lopez, too, thought the piece was short and could have included more questions about why CMS has allowed obvious fraudulent claims to be processed. Still, while Allen's follow-up had its shortcomings, it has given providers and other industry stakeholders a valuable tool, he said.
"It's really good that [Allen] included the comments from CMS. I think that is the perfect thing for people to go in with when they see their congressman," Lopez said. "It's a huge advantage for those of us who go and lobby our congressmen and senators because it shows they haven't been getting 'the whole truth and nothing but' for years."
View a transcript of the Nov. 6 report.