Monday, January 14, 2008

Why has it taken Medicare so long to impose effective measures to prevent fraud?

In a press release distributed to the national media January 8, 2008, the American Association for Homecare stated that it welcomes and supports efforts to crack down on Medicare fraud announced in Los Angeles earlier the same day in another of a series of press conferences held by the Centers for Medicare and Medicaid Services (CMS) on the subject.

Even before the Medicare program initiated new quality standards and accreditation requirements under the Medicare Modernization Act of 2003, the Medicare program was supposed to conduct an unannounced facility site visit before granting a Medicare supplier number to providers of durable medical equipment. The Medicare program also was supposed to conduct an unannounced site visit at least once every three years in order for the supplier to have its supplier number renewed.

A site visit is supposed to be more than just checking to see if the lights are on at the location. An inspector conducting a site visit has a number of requirements that he or she should be looking for such as verifying delivery slips and checking to make sure there is a complaint file. Unfortunately, Medicare does not seem to do this on a regular basis.

The Los Angeles Times printed a piece entitled Feds to enforce tighter restrictions to help prevent Medicare fraud (,1,5998232.story?ctrack=1&cset=true). The written piece as well as the press conference linked fraud and abuse efforts with accreditation as required by the competitive bidding program.

See the full text of the press release at the Newsroom at

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