AAHomecare has released a 13-point plan that it says would eliminate most Medicare fraud typically attributed to the HME industry and help recoup billions of lost dollars.
“Taxpayer dollars lost to fraud represent theft of resources needed by seniors and people with disabilities,” said AAHomecare President and CEO Tyler Wilson. “So, we are sharing these aggressive new recommendations with Medicare and its contractors, Congress, the Department of Justice and the FBI in the hope that we can keep criminals away from the Medicare program.”
The new plan includes the following steps:
• Mandate site inspections for all new HME providers. AAHomecare says a July GAO report underscored the need for CMS to ensure that its contractors are conducting effective site inspections for all new applicants for a Medicare supplier number.
• Require site inspections for all HME provider renewals. The plan says all renewal applications should require an in-person visit by the National Supplier Clearinghouse (NSC), the CMS contractor that ensures integrity in the Medicare program.
• Improve validation of new providers. The association says that additional validation of new providers should be included in a comprehensive application process for obtaining a Medicare supplier number.
• Require two additional random, unannounced site visits for all new providers. The plan calls for two unannounced site visits that should be conducted by NSC during the first year of operation for new HME providers.
• Require a six-month trial period for new providers. The plan says the NSC should issue a provisional, non-permanent supplier number to new suppliers for a six month trial period. After six months of demonstrated compliance, the provider would receive a standard supplier number.
• Establish an anti-fraud office at Medicare. AAHomecare says CMS should establish an office with the sole mandate of coordinating detection and deterrence of fraud and improper payments across the Medicare and Medicaid programs.
• Ensure proper federal funding for fraud prevention. The plan calls for increased federal funding to ensure that NSC completes site inspection and other anti-fraud measures.
• Require post-payment audit reviews for all new providers. The association says that Medicare’s program to safeguard contractors should conduct post-payment sample reviews for six months worth of claims submitted to Medicare by new providers.
• Conduct real-time claims analysis and a refocus on audit resources. The plan says Medicare must analyze billings of new and existing providers in real time to identify aberrant billing patterns more quickly.
• Ensure all providers are qualified to offer the services for which they are billing. The association says a cross-check system within Medicare databases should ensure that homecare providers are qualified and accredited for the specific equipment and services for which they are billing.
• Establish due process procedures for suppliers. The plan calls for CMS to develop written due process procedures for the Medicare supplier number process, including issuance, denial and revocation of the Medicare supplier number. The procedures must include, for example, an administrative appeals process and timelines.
• Increase penalties and fines for fraud. The plan says Congress should establish more severe penalties for instances of buying or stealing beneficiaries’ Medicare numbers or physicians’ provider numbers that may be used to defraud the government.
• Establish more rigorous quality standards. AAHomecare says that Medicare should ensure that all accrediting bodies are applying the same set of rigorous standards and degree of inspection to their clients.
