Video: Rep. Meadows Roasts CMS on Audits

North Carolina takes CMS to task on ALJ delay during House Oversight and Government Reform hearing.

Apparently fed up with CMS’s lack of responsiveness when it came to his queries regarding the negative impact audits were having on small HME provider businesses in his district, Rep. Mark Meadows (R-N.C.) grilled a CMS official in Congress.

Rep. Meadows pointedly asked CMS’s Shantanu Agrawal about CMS’s mismanagement of the audit backlog during a House Oversight and Government Reform Committee hearing.

Watch the full video:

CMS says its backlog of audits awaiting review has nearly reached the 1 million case mark. Furthermore, the agency’s Office of Medicare Hearings and Appeals recently announced it would delay assigning Adminstrative Law Judges to cases for two years. This creates a number of serious problems for providers.

“Here we are with the budget request that says the backlog is going to reach 1 million,” Meadows said during the hearing. “At what point does it become a crisis? At what point? When you start putting companies out of business? You already are! When does it become a crisis that you are willing to do something about?”

Agrawal replied that if the audit process was putting companies out of business that the agency had the flexibility to work with them, but Meadows was not satisfied with the response, and argued it flew in the face of his personal experience.

“But you don’t,” the lawmaker said. “I’ve already called on behalf of my constituents. That would be a great response but it’s not true. I’ve dealt with Jonathan Blum. I’ve called to make sure Kathleen Sebelius knew about it. I’ve called the White House — and you say, ‘too bad.’ So, what do I tell the moms and dads who are going to lose their jobs because they do not get a fair hearing?

“… If the backlog is ten years, what do [these companies] do?” he added. “Do they just pay it? Right now at a million appeals the best adjudication rate we’ve had is 79,000 a year. Even with your budget increase, that would still be a 10-year delay. That’s a taking in my book. Would you wait 10 years for your salary?”

About the Author

David Kopf is the Editor of HME Business.


Thu, May 29, 2014

CMS no longer stands for the Center for Medicare and Medicaid SERVICES. It stands for the Center for Medicare and Medicaid SALARIES. The bureaucrats' only priority is protecting the funding of their jobs and retirement, without regard for those they are charged with serving. Shameful!

Tue, May 27, 2014

I am actually writing because I own a DME Supplier. We have been growing very fast. We have all but stopped providing any products that have a large Medicare patient population to avoid caring for Medicare patients because the current audit atmosphere is HIGHLY PUNITIVE. We have $150,000 worth of Medicare Appeal Recoupment that is ABSOLUTELY unwarranted. We have all the documentation that is overwhelmingly supportive of our proper reimbursement. It has been over 3 years since this began and we are still waiting for our ALJ hearing. Furthermore, we have never lost an appeal at ALJ. It is very sad to think that Medicare's solution to lowering health care costs is to eliminate health care providers.

Tue, May 27, 2014

Amen to the above post!!! It's about GD Time someone with some type of authority stands up to CMS and their bullying! We are a Mom and Pop family operation with a total of 6 employees including Mom and Pop. CMS has taken back over 3 *** from us just last year and quiet frankly, I don't know WHEN I'm gonna get my turn at a hearing. What needs to happen is that someone's loved one that works for CMS needs to go through the BS process of obtaining DME to see how it actually works, and the icing on the cake would be for them to be in a CB area, and have to chose from a list of providers who aren't even located in that particular CB area and let's see how fast they can get equipment.

Tue, May 27, 2014

Way to go, Mark Meadows! As a therapist working for over 40 years with the disabled in my community, the CMS disaster is not only crippling DMEs but it is ultimately leaving the disabled unattended, without the vital equipment they require to function day to day. Yes, there is abuse but when doctors and therapists can document a true medical necessity for the equipment being requested, why does CMS persist in denying the requests?? I am spending up to 30-40 hours in some cases, justifying and then re justifying replacement equipment for individuals who have been using the same (or equivalent) equipment for many years. Yet now, they do not qualify??? Their condition has certainly not changed, if anything in most cases they have become even more disabled because of their lack of access to care and equipment. No wonder, so many practitioners are opting out of the system. I pray that the families of the CMS auditors and the legislators who allow this mismanagement of te Mediciare/Medicaid programs, someday receive the same scrutiny and neglect that my patients are being subjected to. Maybe then they will begin to understand... .

Tue, May 27, 2014

every day we are receiving audits in the mail, when we request information on why the case is under audit we are not given a reason and are told to resubmit the case. If CMS can't tell us why it's under audit how are we supposed to correct it if we are providing all the information CMS policy states is required. After cutting employee salaries by 10%, cutting benefits, and letting employees go (13 employees to 6). We have to now assign a full time employee to manage the audits. In most cases the information that was initially submitted was what was needed, we are finding that the individuals that CMS has contracted to perform audits don't understand CMS policy and we are having to train the employees on their own policy. Our referrals are tired of dealing with us do to the fact that we are requesting more office notes or requesting patients see their physician to create more notes hoping that is what is needed. It will cost medicare more money to have patients visit their physicians over and over as we try to determine why a patients Hospital bed, Portable O2 is under audit. In a few circumstances it has been due to physician name not printed directly under signature, But was printed above or to the side. We are struggling unlike our larger competitors who are able to purchase DME at a cheaper rate, it's not fair. In a system were we are regulated on reimbursement but we have to pay higher rates for our DME than larger companies. Free market has been eliminated and CMS is holding the payment for services we have already performed.

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