WASHINGTON--A National Public Radio report that zeroed in on Medicare fraud involving HME has generated a blitz of angry responses from providers who charge that the story was one-sided and cast all providers "into the category of crooks."
The brouhaha erupted on Oct. 11 when NPR aired reporter Greg Allen's piece on its "Morning Edition" show. Allen focused his story on Medicare HME and infusion fraud in South Florida, working mainly from law enforcement interviews.
"The major objection was imbalance. The majority of the respondents opined that it was one-sided. [NPR] should have contacted [the American Association for Homecare], they should have contacted [the Florida Association of Medical Equipment Suppliers] or they should have contacted VGM. And they didn't," said Mark Higley, vice president of development for Waterloo, Iowa-based VGM Group.
Allen painted a picture of an industry infiltrated by drug dealers.
"DME companies have been favorite fronts for people engaging in Medicare fraud for a long time because they're easy to set up," he said in the piece. He reported that "fraudulent claims estimated at between $300 million and $400 million were prosecuted in just two South Florida counties in the past year" and that "estimates of total losses range as high as 10 times that much."
"Medicare fraud has now become a favorite career path of many former drug dealers," Allen said. "The FBI has interviewed drug dealers and asked them why they're moving from cocaine to wheelchairs and walkers."
He also quoted Malcolm Sparrow of Harvard's Kennedy School of Government, who offered the opinion that drug dealers were moving into the HME arena because "there's more money, there's much less chance of being caught and if I do get caught, I'll be treated like a white-collar criminal, not like a drug dealer."
For an industry already being hammered by evaporating reimbursement, competitive bidding and looming legislative and regulatory edicts, it was too much.
"It's just one more hurdle that we in the industry have to face. It couldn't have come at a worse time," said John Gallagher, VGM's vice president of government relations.
The buying group e-mailed and faxed its members and affiliates, encouraging them to contact NPR and Allen himself to protest the story. Many did.
Allen told HomeCare Monday last week that he has received about 60 or 70 e-mails and nearly a dozen phone calls since the piece aired. About a half-dozen were "very positive," he said. The rest were angry.
"You have no idea how much harm you may cause to an industry which is so vital to our seniors and disabled," wrote one Michigan-based provider. "Your report will cause harm by incurring additional budget cuts and legislative backlash towards the poor, seniors and the disabled."
Penned another from Georgia, "I was appalled to hear your story Oct. 11 where you compare DME suppliers to drug dealers without mention that most DME suppliers are ethical business people supplying medical equipment that allow patients to get home more quickly, [thus] lowering overall health care costs by reducing the length of hospital visits."
"Everybody says I am comparing DME providers to drug dealers. And I do not do that in the story," Allen insisted. He said he was surprised by the response. Allen also said he thought he "would have gotten a strong response from CMS," but added that he had heard nothing from that quarter.
"When I first did the story, it was not about DME providers, it was about fraud," he explained. "My main intent was trying to draw the general public in [to the issue of Medicare fraud]. It was not written for the DME crowd."
But providers and others in the industry challenged the depth of his research. Allen quoted Sparrow, FBI personnel and an infusion patient, but no HME providers.
"This is an extremely unfair portrayal, and I would ask that you would do a little research and even contact a few of us that are doing things right," a provider from Missouri wrote the reporter. He also said Allen lumped all HME providers "into the category of crooks."
The Missouri provider was one of many who invited Allen to their facilities to see an HME business up close and personal, pointing out that blame for the fraud and abuse lies with the government itself.
"You accurately point out rampant fraud in the Miami area," the Missouri provider said in his message to Allen. "We believe the government should prosecute the involved individuals and entities to the fullest extent of the law. But the real crime is that CMS has failed to police the program for years ... The solution is to use the existing regulations and enforce them."
The response has been so hot and heavy that Allen said he will meet later this month with a provider and talk to others to hear their side of the story.
"I know DME providers are very concerned about this. I don't think anyone in the community disputes that there is a lot of fraud out there and it is making everybody's life miserable and the government isn't policing it," Allen said. "The next story I'm going to do is from the DME providers' view. I think they have a lot of good stories to tell."
Raul Lopez, director of operations for Bayshore Dura Medical in Miami Lakes, Fla., and president of FAMES, said he and Allen are scheduled to meet Oct. 31. "The meeting will take place in my office, and he will receive a tour of the facilities prior to the interview," Lopez said.
Lopez added he is hopeful that Allen will gain a better understanding of the HME industry: the services that legitimate HME providers offer, the difficulties they encounter with reimbursement, and the efforts that have been made by state and national associations, buying groups and individual providers to combat fraud.
"I also want to be able to point out failures on [the parts of CMS and their contractors] that have allowed so much fraud to be perpetuated," Lopez said. "Maybe it will put us in a little better light."
Read the NPR report.