As I read the Feb. 25 announcement from the Department of Health & Human Services (HHS) and the Centers for Medicare & Medicaid Services (CMS), my heart began to break — for you, for your teams, and your patients.
I began covering the durable medical equipment, prosthetics, orthotics and supplies space in January 2002. “Fraud, waste and abuse” were among the first words I learned upon entering an industry still suffering fallout from the “Golden Commode” period.
Over the following years, we saw supplier standards expanded and toughened. We saw accreditation requirements enacted. And yes, we saw Medicare competitive bidding put so many suppliers out of business.
The part about fraud, waste and abuse rarely recognized by policy makers is this: The hard-working, honest, diligent suppliers are among the hardest hit — not because they did anything wrong, but because long after fraudsters have moved on to other industries and new victims, the real DMEPOS suppliers are left to pick up the pieces: to deliver oxygen to patients with congestive heart failure; to provide continuous glucose monitors to patients with diabetes; to repair wheelchairs and teach newly diagnosed sleep apnea patients how to fit their masks.
They have to carry on while laboring under measures meant to punish criminals long gone, fraudsters who were never really DMEPOS suppliers to begin with.
“CMS is done trying to catch fraudsters with their hands in the cookie jar,” CMS Administrator Mehmet Oz said in the announcement. “Instead, we’re padlocking the jar and letting them starve. This proactive approach will help us crush fraud, protect taxpayer dollars, and make sure the vulnerable Americans who depend on our programs get the care they need.”
That’s what honest suppliers want, too. And amidst this latest crackdown — one that resurrects those decades-old accusations — industry organizations are taking the high road. Again. Still.
“The federal moratorium on new DME suppliers presents a defining moment for us as an industry — an opportunity to demonstrate that the VGM members serving patients are the gold standard,” The VGM Group said in a Feb. 26 statement. “We have long shown that our members operate with integrity, excellence in compliance, and unmatched commitment to service, efficiency and patient outcomes. Now, we must elevate that message.
“This moratorium gives VGM members a unique chance to highlight their value to legislators, regulators, and the communities they serve. By leaning into transparency, strengthening best practices, and showcasing the positive impact VGM members have on patient health and health care savings, together we can elevate our visibility as true health care champions.”
“We appreciate CMS Administrator Oz’s demonstrated commitment to preventing criminals from enrolling in the DMEPOS program,” said Josh Marx, CEO of Medical Service Company and chairman of the board for the American Association for Homecare (AAHomecare). “We hope to work with CMS to strengthen enrollment practices without harming patients and communities by mandating a complete halt to new enrollments for existing providers.”
AAHomecare has also indicated it will respond to a CMS request for information (RFI) “on ways the agency can strengthen defenses against Medicare fraud, seeking input from a broad range of stakeholders — including states, providers, suppliers, payers, technology companies, patient advocates and beneficiaries. CMS suggests that a proposed rule may follow and be informed by responses to their RFI.”
For an industry already running notoriously lean on paper-thin margins, these efforts will require additional, uncompensated work … not to mention more stress, longer hours, more weekends.
And yet, while undoubtedly feeling frustration privately, the industry is responding publicly with a spirit of cooperation and collaboration, while keeping Medicare beneficiaries at the heart of their actions.
I am so sorry you are once again in the middle of the storm, taking the brunt of the winds and hail.
But I remain so incredibly honored to cover this industry. Your professionalism and dignity, and the respect and care you show your patients … they matter.
So — let’s stick together. Let us hold each other up and lean on each other. And then let’s go — again.
