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Legislation & Regulation

Coverage of federal and state legislation and regulation affecting HME providers, home health agencies and patients.

  • Ready Set Hold It!

    How many times were we told that the Health Insurance Portability and Accountability Act (HIPAA) electronic transaction set would be implemented on Oct. 16, 2003? Well, in an effort to allow providers to turn the switch and bill the new ANSI format, it was found that many of our trading partners, for whatever reason, were not ready for the event. So, the Centers for Medicare and Medicaid Services has activated a contingency plan that grants an extension to that well-publicized deadline. This does not mean that HIPAA is going away. Providers must show a good faith effort in complying with the new electronic guidelines for claims submission. Have you developed a plan? Is your software vendor ready? Are you electronically transmitting now under the ANSI…
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  • ACHC Prepares for ISO 9001: 2000 Certification

    Raleigh, N.C. The Accreditation Commission for Health Care (ACHC) is preparing for ISO 9001: 2000 certification. ACHC said it is taking the step to control growth, improve efficiency, strengthen accountability and achieve a higher level of competency, among other factors. “We are submitting ourselves to outside peer review the same as those companies that go through our accreditation process,” said ACHC President and CEO Tom Cesar. ACHC’s accreditation programs include HME; home infusion; rehab technology supplier services; home health; hospice; women’s health care; specialty pharmacy; and medical supply provider services. For breaking news, go to www.homecaremonday.com, the electronic news service of the home medical equipment industry.
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  • Latest Legislation & Regulation News

  • Houston Power Wheelchair Indictment Unsealed

    Houston The U.S. Attorney for the Southern District of Texas has released details of a Houston power wheelchair fraud case that caused the Centers for Medicare and Medicaid Services to implement its “Operation Wheeler Dealer” crackdown. U.S. Attorney Michael Shelby’s office unsealed a 101-count indictment charging six individuals with conspiracy, health care fraud and receiving or paying illegal kickbacks in the multi-million-dollar scheme. The defendants allegedly billed Medicare and Medicaid a total of $32 million and received $16 million for fraudulent claims, according to the indictment. Dr. Anant Mauskar, owner of a Houston medical clinic, is alleged to have routinely received kickbacks from owners of DME companies and individuals for falsely prescribing power wheelchairs. Nadine Norman, Mauskar’s office manager, is accused of setting and receiving…
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  • Editor’s Inbox

    Editor’s Note: The recent federal crackdown on power wheelchair fraud sparked an outpouring of response from many HomeCare readers. The following letters represent two perspectives on the issue. Discovery of Fraud and Abuse an Achievement, Not an Embarrassment In your Aug. 25 article (“PMC Commends Fraud Crackdown,” HomeCare Monday), the opening paragraph included the phrase “threatened to tarnish the HME industry’s reputation at this critical juncture.” This [phrase] absolutely drives me crazy! It is well known that fraud and abuse related to [power] wheelchairs and scooters is rampant in our industry. The problem is that we are not tough enough to police ourselves. The fact that we have to kowtow to legislative efforts to rein in Med i-care costs at this time by making concessions…
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  • Leading the Charge

    “Here in Washington, we encourage everyone to speak with one voice by ensuring all of our efforts are focused on one message,” according to Kay Cox, president of the Alexandria, Va.-based American Association for Homecare. And, she says, she intends for that home care message to be heard. Immediately after stepping into her new role on June 1, Cox was faced with leading the charge against proposed Medicare reform measures — competitive bidding, copayment of the home health benefit — that she labels as “very harmful to home care patients and providers.” Though at press time the legislation was stalled in conference committee, the association continues to press the home care cause with a concerted national lobbying effort and a companion grassroots campaign. Cox has…
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  • Medicare Reform Progress Slow, But Still Going

    Washington After weeks of partisan wrangling, conferees from the House and Senate have reached agreements on several of what they called “non-controversial” Medicare-reform issues, including expansion of the “homebound” definition. With “glass-is-half-full” optimism, Conference Chairman Bill Thomas, R-Calif., touted the accomplishment as a promising sign for the prospect of a final agreement. “We’ve made headway on scores of provisions in eight titles,” he said, “and I am pleased to announce nearly one-third of the Medicare bill has been resolved.” But Thomas’ fellow House Republicans were more inclined to point out the empty half of the glass when they sent a letter to House Speaker Dennis Hastert, R-Ill. In the letter, conservatives warned they would vote against any compromise bill that does not include provisions for…
    Read More →: Medicare Reform Progress Slow, But Still Going

  • Bogus Company Fraud in Florida

    Miami After a two-and-a-half-year investigation, federal prosecutors have charged 11 individuals with participating in a scheme that used bogus DME companies to bill Medicare more than $20 million. The charges follow the August arrest of Alfredo Omar Rodriguez, who allegedly directed other individuals to form bogus companies and bill for DME services that were not provided, according to Marcos Daniel Jimenez, U.S. Attorney for the Southern District of Florida. For breaking news, go to www.homecaremonday.com, the electronic news service of the home medical equipment industry.
    Read More →: Bogus Company Fraud in Florida

  • Suffering from Rule Overload?

    Welcome back to Compliance University — Class is now is session! This month I will begin a “maxi-series” of articles to address a major problem home care providers face: Rule Overload. Let’s listen to the home care providers’ lament: “Help! We must track hundreds of reimbursement rules, OSHA rules, CLIA rules, anti-fraud rules, privacy rules, security rules, government rules and private payer rules! It’s too much to monitor, let alone conquer. We’re at the end of our rope!” Clearly, these providers suffer from that new malady “Rule Overload.” Perhaps HIPAA has elevated the rule-overload problem to epidemic proportions by imposing specific and detailed regulatory obligations with firm deadlines for compliance. While it is true that new reimbursement rules also have firm deadlines for enforcement, the…
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  • Pulling Together On Capitol Hill

    “We’ve got to be a team. Teamwork wins. If we don’t hang together, it’s for sure we’re going to hang separately.” Shelly Prial, HomeCare magazine, November 1999 The question is, is the home health care industry, circa 2003, hanging together? Or is it still in danger of hanging separately? Four years ago, just before the calendar flipped over into a new century, the industry — home medical equipment, home health agencies, home infusion, respiratory and rehabilitation — was in turmoil. Reimbursement was on a downhill slide. Federal mandates such as inherent reasonableness, competitive bidding, consolidated billing and the interim payment system were wreaking havoc in HME businesses and HHAs alike. Many simply shut up shop. Key stakeholders prescribed one antidote for the industry’s critical condition:…
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  • AAHomecare Continues Lobbying Effort with Open Letter to Congress

    As of press time, the American Association for Homecare had collected more than 3,500 letters in its grassroots lobbying campaign to oppose provisions in the House of Representatives’ Medicare reform bill “that are very harmful to home care patients and providers,” AAHC President Kay Cox said. Urged Cox, “Remember, anyone can sign on to this letter — patients, family members, even someone who’s simply concerned about our nation’s elderly and disabled, so don’t hesitate to distribute the letter to family members or co-workers.” Based on the association’s latest tally, Maryland, Virginia and Pennsylvania have submitted the most letters so far. To download a copy of AAHC’s open letter to Congress, go to www.aahomecare.org. For breaking news, go to www.homecaremonday.com, the electronic news service of the…
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  • White House Letter Encourages States’ Recovery Efforts

    Washington The Bush Administration’s Office of Management and Budget in May clarified its policy about state recoveries of erroneous government payments, explaining that states may use a portion of the money they collect to pay for audits of government contractors. A glitch in federal guidelines, which appeared in the Improper Payments Information Act of 2002, caused some states to drop recovery efforts, fearing that costly audits would burden lagging budgets. To clarify the misunderstanding, OMB Controller Linda Springer issued a memo to states, explaining that collection firms may receive reasonable fees based on the amount of federal money they recover — and that states may pay these fees using some of the recovered funds. “We’ve analyzed a portion of the programs and already know that…
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  • AAHomecare Supports Accreditation Provision

    Alexandria, Va. During the weeks since the Senate made public its Medicare-reform bill, members of the durable medical equipment industry have debated hotly a provision that would require all DME providers to become accredited within three years of the bill’s passage. The American Association for Homecare has been vocal about other provisions of the Senate bill; however, until July 10, the association had not stated its position on the accreditation issue. While some providers hailed the accreditation provision as one that would help the DME industry combat negative stereotypes, others complained that the provision would harm small companies. “The cost and man hours to prepare for a survey is prohibitive for most small independents,” D. Rexford Maxey, president of Penn-York Medical Supplies in Binghamton, N.Y.,…
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