Ridding the Industry of Fraud and Abuse

While DME experts believe that fraud and abuse should be wiped out, they also believe that
competitive bidding is not the answer.

It’s no secret that the first instated competitive bidding program did not accomplish what it set out to do.
“Unfortunately, part of the thought process of the bidding program is a mechanism to eradicate fraud and abuse,” says Cara Bachenheimer, senior vice president of government relations at Invacare Corp.

But if you step back and take a look at it from CMS’s perspective, it would clearly be easier to provide some kind of oversight to the supplier community if there were fewer claims to audit, says Rita Hostak, vice president of government relations for Sunrise Medical.

“Unfortunately, I do see it as the smaller that the bucket is, the easier it is for CMS to manage,” She says.
Hostak does, however, believe that there are other ways to remedy this problem without the need of a competitive bidding program. One way is putting filters on claims and looking for utilization trends. It should also be the responsibility of CMS to visit all DME suppliers to make sure that they are a legitimate provider, she added.

“We believe the gates need to be tightened just for the initial outset in terms of how the government hands out billing numbers to new companies,” Bachenheimer says. There should be greater scrutiny of new companies as well.

The government also needs to use the technology that currently exists — just as banks are able to identify aberrant charging behavior on credit cards, the same type of technology could and should be used to identify aberrant claims.
“At this point, it takes a ridiculous amount of time for CMS to understand that activity has occurred,” Bachenheimer says. “It usually takes several years and by that time those criminals are long gone.”

The American Association for Homecare and other industry leaders such as Pride are working closely on the development of antifraud measures that could go to the Senate Finance Committee and the House Ways and Means Committee to raise the standard within the industry, says Seth Johnson, VP of government relations at Pride Mobility Products. He says that efforts are being made to ensure that the “fly by night providers that are responsible for perpetrating fraud no longer view this industry as a place where they can come in and make a quick buck.”

For more information on what AAHomecare is doing to stop Medicare fraud, please visit: http://www.aahomecare.org/associations/3208/files/Homecare%20Sector%20Recommends%20New%20Programs%20to%20Prevent%20Medicare%20Fraud.pdf


This article originally appeared in the December 2008 issue of HME Business.

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