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.