Tuesday, August 26, 2008

Patient Weighs in on New York Times Article

New York Times
August 26, 2008
Medicare Bidding

To the Editor:
In your Aug. 22 editorial “Medicare’s Claims,” you refer to the postponement by Congress of a new competitive bidding system for durable medical equipment. Such a system might sound great, but it does not serve or help people with disabilities. It can literally kill us.
Fraud is not good. But when a person with a disability needs a specific wheelchair, custom seating system or ventilator, you cannot award the right to supply some lesser-quality piece of equipment to the lowest bidder. That will only result in a greatly reduced quality of life — and possibly death — for that severely disabled person.

Moreover, surgical suppliers of such advanced and often custom equipment are already working on an extremely low profit margin. If the government starts awarding funds to the lowest bidder, it would reduce the ability of surgical suppliers to stay in business.

I use a $20,000 power chair for mobility and a $15,000 vent to breathe. This equipment has allowed me to drive, teach, write books and plays, and enjoy a full life. Allow competitive bidding, and I’d be using inferior equipment and my quality of life would be compromised.

To understand this complicated situation, you need to walk in our shoes — or live in our wheelchairs — for a while. Let’s reduce fraud. But let’s not destroy the equipment suppliers or people with disabilities in the process.

Robert Mauro
Levittown, N.Y., Aug.
22, 2008


Monday, August 25, 2008

New York Times Prints AAHomecare's Response to Medicare Fraud Article and Editorial

Fighting Medicare Fraud

To the Editor:

Re “Medicare’s Claims” (editorial, Aug. 22) and “Report Rejects Medicare Data on Less Fraud” (front page, Aug. 21):

It’s important for the federal agency in charge of Medicare to collect and publish accurate Medicare fraud statistics.

We applaud your effort to get to the bottom of Medicare fraud numbers, but it was disappointing to see your article link two separate issues — pricing through competitive bidding and fraud prevention.

Our industry has favored accreditation as a fraud deterrent for decades. The action by Congress in July to delay and fix the deeply flawed bidding program will not reduce or delay efforts to combat fraud.

The exact opposite is true. Congress strengthened the accreditation requirements in the new Medicare law and closed a loophole that would have allowed nonaccredited providers to serve Medicare beneficiaries. We applaud those measures.

We will continue to support efforts by Congress and federal agencies to find more effective ways of keeping criminals out of the Medicare program.

Tyler J. Wilson
Arlington, Va., Aug. 22, 2008

The writer is president of the American Association for Homecare.

To read the comment at the New York Times and leave a comment, visit http://www.nytimes.com/2008/08/24/opinion/l24medicare.html?_r=1&ref=opinion&oref=slogin.

Friday, August 22, 2008

Error in NY Times Editorial “Medicare Claims”

The New York Times published an editorial today which complemented Charles Duhigg’s front page story yesterday. The editorial stated, “Congress must also recognize its own failure to give Medicare an important tool to combat fraud and waste. It postponed a new competitive bidding program for durable medical equipment that would require a more intense look at the qualifications and integrity of the suppliers. With Medicare expenditures soaring, there is no room for any more waste, fraud or complacency.”

To clarify this error surrounding the postponement of the competitive bidding program, AAHomecare submitted the following response to the New York Times comment section: The Medicare bill enacted by Congress on July 15 (the Medicare Improvements for Patients and Providers Act of 2008, HR 6331) INCREASES fraud-prevention measures by setting a statutory deadline for accreditation of home medical equipment providers and by closing a loophole that would have allowed non-accredited homecare providers to serve Medicare beneficiaries. The competitive bidding program is a price-setting mechanism required by the Medicare Modernization Act of 2003. The fraud-prevention piece of that legislation is accreditation. The Times has conflated and confused the two. (The durable medical equipment industry has advocated accreditation for decades and opposed the recent cancellation of deadlines for accreditation of providers in 70 metropolitan areas.) Congress wisely delayed the bidding program in July in order to fix a badly implemented program. Congress insisted that the delay be paid for through a 9.5 percent cut for durable medical equipment to recoup the savings the flawed bidding program would have saved. So the specific criticism of Congress in the editorial is misplaced.

To read the editorial and leave a comment of your own visit: http://community.nytimes.com/article/comments/2008/08/22/opinion/22fri1.html?s=1&pg=3

Thursday, August 21, 2008

NY Times Article Describes CMS-OIG Feud Over Fraud Numbers

A New York Times front page article on August 21 reports of a feud between the Office of Inspector General (OIG) and the Centers for Medicare and Medicaid Services (CMS) regarding the correct amount of fraud by criminals posing as legitimate home medical equipment providers. OIG says CMS is low-balling the fraud numbers after CMS told Congress the amount of fraud related to medical equipment is $700 million.

The top-ranking Republican on the Senate Finance Committee, Charles Grassley (R-Iowa), calls for “heads to roll” at CMS and in the House, Representative Pete Stark (D-Calif.) called CMS “incompetent.” Meanwhile, CMS has been complaining they don’t have enough anti-fraud resources from Congress.
The American Association for Homecare applauds efforts to get the numbers right and more important, to stop fraud in Medicare. However, the reporter for this article, Charles Duhigg, incorrectly describes competitive bidding as a fraud prevention mechanism that was stopped by industry lobbying. The action by Congress in July to delay and fix the deeply flawed bidding program will not reduce or delay efforts to combat fraud. The exact opposite is true. Congress strengthened the accreditation requirements in the new Medicare law and closed a loophole that would have allowed non-accredited providers to serve Medicare beneficiaries.

We will continue to support and help Congress and federal agencies to seek more effective ways of keeping criminals out of the Medicare program.

To read the NY Times article visit: http://www.nytimes.com/2008/08/21/business/21medicare.html?_r=1&hp&oref=slogin.

Wednesday, August 20, 2008

Local Coverage Determination for PAP Delayed

Recent studies have associated cardiovascular disease with obstructive sleep apnea. More than 12 million people are affected by the disorder, and many receive treatment each year with a continuous positive airway pressure (CPAP) machine, which the Centers for Medicare and Medicaid Services (CMS) acknowledges is safe and effective. Yet, the agency continues to provide conflicting policies on payment and testing related to these machines.

Most recently CMS provided new local coverage determinations (LCD) for PAP devices, requiring the new policies to go into effect on September 1, 2008 without offering a comment period and providing less than an ideal amount of time to implement the changes. The American Association for Homecare worked with industry stakeholders to delay the implementation date by sending a letter stating our concern for the quick implementation date and lack of input from the industry.

Yesterday, the Durable Medical Equipment Medicare Administrative Contractors (DME MACs) for Jurisdictions A, B, C, and D announced a delay of the September 1, 2008 implementation date.

Full text of AAHomecare’s letter objecting to the September 1 deadline is available at www.aahomecare.org.

A revised policy will be published in the near future which we have requested provide at least 90 days before the implementation deadline.

Tuesday, August 19, 2008

“Medicare cuts take air from elderly Benefits capped for portable oxygen tanks”

The AARP Bulletin Today, a bulletin featuring daily news and information for senior citizens, tackled the issue of capping Medicare benefits for portable oxygen tanks and concentrators in a July article. The cap will mean that people currently on oxygen will become responsible for maintenance, repairs and replacement of their existing equipment after 36 months of rental.

At a cost of about $7.60 per day, oxygen therapy is cost-effective and is critical to approximately one million Americans who suffer from respiratory illnesses such as chronic obstructive pulmonary disease (COPD) and who require oxygen therapy under Medicare. Nationwide, as many as 15 million Americans have been diagnosed with COPD, a number that is growing.

The article quoted that the American Association for Homecare, which states that the typical Medicare home oxygen beneficiary is a woman in her 70s who suffers from late-stage chronic obstructive pulmonary disease and as a consequence has severe low levels of oxygen in her blood. Approximately 12 million Americans have been diagnosed with COPD, and an additional 12 million more remain undiagnosed.

The analysis shows more than 1.4 million Medicare beneficiaries will be impacted by the changes, amounting to approximately a $325 cut per patient. AARP said this new change is “cutting off the air supply to millions of elderly Americans.”

To read the full article in the AARP Bulletin visit: http://bulletin.aarp.org/states/ok/articles/medicare_cuts_take_air_from_elderly_benefits_capped_for_portable_oxygen_tanks.html

Thursday, August 7, 2008

“A Simple Little Market Test of What Government Must Pay for Bed Pans”

It was a “simple little market test of what government must pay for bed pans.” That’s how former House Ways and Means Committee Chairman Bill Thomas recently described the Medicare competitive bidding program for durable medical equipment.

Thomas is unhappy that Congress decided to delay the program in order to get it right. The roll-out of the first round of the program in 10 metro areas was an unqualified disaster that would have vastly reduced competition and access to care for seniors and people with disabilities.

It should be noted that the bidding program, in fact, is not “simple,” it is not “little” in the context of the home medical equipment sector, it is not a “test,” and it has nothing to do with “government payments for bed pans.” But aside from those errors, Thomas’ comment is 100 percent accurate: It has something to do with the “market.” Sadly Thomas’ angry dig at home medical equipment is emblematic of the distain for homecare and homecare providers that festers in some corners of Washington’s policy world.

But if so-called Medicare reform proponents can’t even describe this one small sector of Medicare accurately or competently, how in the world are they going to actually design and implement reform in the other sectors of Medicare, where more than 98 percent of the dollars are being spent and where the growth is occurring?

By describing the bidding program as essentially dead, Thomas, like top Medicare and HHS officials, has admitted Congress has little confidence in the ability of the federal Centers for Medicare and Medicaid Services (CMS) to implement a fair competitive bidding program.

The American Association for Homecare will continue to work with Congress and CMS toward policies that preserve access to care, foster competition, and are fair to the homecare providers who provide medically required equipment and therapies to people in the most cost-effective setting in the U.S. – at home.

CQ HealthBeat reported Thomas’ comments last Friday. See

Miami Herald Prints AAHomecare's Response

Letter to the Editor, published August 7, 2008 in response to the Miami Heralds series on Medicare Fraud.

Don't ignore Medicare fraud

Several points in The Miami Herald's series on Medicare fraud merit attention. The federal Centers for Medicare and Medicaid Services recently canceled an accreditation deadline -- which is certainly an anti-fraud measure -- for suppliers of durable medical equipment -- oxygen therapy, wheelchairs, diabetic supplies, etc.

We oppose that cancellation. The government should use the ample authority that it already has to combat fraud more effectively. Criminals who have been allowed into Medicare have tainted the entire durable-medical-equipment sector, which provides cost-effective care for seniors and people with disabilities who require medical devices, services and therapies in their homes. Those facts should not be lost in the discussion about the future of Medicare.

Our industry has zero tolerance for fraud. Congress estimates that fraud and improper billing in Medicare cost us $70 billion a year. The share that durable medical equipment makes up is $700 million -- far too much, but about 1 percent of the total. South Florida obviously is a hotspot for equipment fraud and has received extra enforcement efforts and resources. The national figures beg the question: Why aren't the government and media focusing more on the other 99 percent of fraud, which represents $69 billion-plus in taxpayer theft or waste?

TYLER J. WILSON, president, American Association for Homecare, Arlington, Va.

DME Unfairly Serves as “Fall Guy” for Medicare Fraud

$70 billion is lost annually to Medicare fraud. Despite 99 percent of fraud in Medicare occurring outside of the DME sector, homecare seems to be taking the brunt of the press and attention in Congress.

Senator Mel Martinez (R-Fla.) chaired a forum on Capitol Hill to discuss Medicare fraud last week. Many of the examples of fraud presented during the forum focused on the DME industry. The Senator also introduced the “Seniors and Taxpayers Obligation and Protection (STOP) Act”, S. 3164, which is designed to combat fraud in Medicare. The bill would establish a system for unique identifiers of certain durable medical equipment, urge HHS to implement the DME surety bond requirement that was enacted in the Balanced Budget Act of 1997, require monthly verification of the accuracy of charges for physicians’ services, provide for a study of real-time data review, and amend the Medicare enrollment application.

Prior to the forum by Sen. Martinez, AAHomecare released a statement to the media opposing the decision by CMS to cancel the accreditation deadline for durable medical equipment providers in the 70 metropolitan areas throughout the U.S. designated for Round Two of the Medicare competitive bidding program. Tyler Wilson, president and CEO of AAHomecare said, “The home medical industry has advocated accreditation of homecare providers for three decades because accreditation helps ensure quality care for Medicare beneficiaries and can serve as a powerful tool in preventing fraud.

This week more examples of DME fraud were released through a Government Accountability Office (GAO) report. GAO investigators set up “sham” companies to test Medicare contractors, which were awarded Medicare business and passed all checkpoints. The Centers for Medicare and Medicaid Services has the tools already at their disposal to stop fraud and abuse but they continue to fall short on their commitment to Medicare beneficiaries and taxpayers.

AAHomecare is working through a variety of channels to ensure that the DME industry is not unfairly tarnished by misleading statements or by news accounts on the topic of Medicare fraud and will continue to offer help to CMS to combat fraudsters from entering into mainstream businesses.