Monday, September 22, 2008

AAHomecare Takes a Stand Against Medicare Fraud

In recent months the media and Congress have been focusing on Medicare fraud and initiatives to help curtail the rising cost associated with fraud. The American Association for Homecare (AAHomecare) supports Congress efforts. Fraud hurts all legitimate home medical equipment providers.

AAHomecare is currently working on a legislative strategy that will help keep criminals out of Medicare. The Association staff is reviewing specific measures that could be used by the Centers for Medicare and Medicaid Services (CMS) to stop fraud at the front-end of the payment process rather than relying on the current pay-and-chase system. The measures focus on increased scrutiny of new HME providers, real-time claims analysis, and accreditation, among other topics.

Over the past year, AAHomecare has worked closely with congressional offices on two separate anti-fraud efforts, including a rational approach to implementation of surety bond requirements for home medical equipment. In addition, AAHomecare staff provided input to Senators drafting the STOP Act, (Seniors and Taxpayers Obligation Protection Act of 2008, S. 3164) which requires the Secretary of Health and human services to change the Medicare beneficiary identifier used to identify Medicare beneficiaries under the Medicare program.

The Association has gone on record opposing the exemption from accreditation requirements for “eligible professionals” as outlined in section 154 (b)(F) of the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA). According to CMS, this includes physicians, physical or occupational therapists, qualified speech-language pathologists and practitioners are exempt as “eligible professionals.” This list also includes physician assistants, certified registered nurse anesthetists, and clinical social workers, among others. Home medical equipment providers are not exempt. AAHomecare has also opposed an earlier announcement by CMS to postpone the accreditation deadline for providers taking part in Round Two of the DMEPOS Competitive Bidding Program.

Tyler J. Wilson, president and CEO of AAHomecare has commented that “accreditation helps to ensure that patients receive high-quality homecare, and it is also an important tool in preventing fraud in the Medicare program.”

Friday, September 12, 2008

Orlando Sentinel Publishes Industry Response to Fraud and Abuse Column

Home care can help fix Medicare

Tyler J. Wilson, September 12, 2008
The Orlando Sentinel's Sept. 4 editorial, "Congress needs to crack down on Medicare fraud to protect the program," states the obvious by using the word "outrageous" to describe the billions of dollars lost each year to Medicare fraud. There is plenty of blame to go around.

Yes, Congress needs to insist that the federal agency that oversees Medicare receives and wisely spends a greater proportion of resources on fraud prevention.

Yes, the federal agency, Centers for Medicare & Medicaid Services, needs to do a much better job of using its authority and resources that Congress has already approved and implement some fraud-prevention measures that Congress approved more than 10 years ago.

The home-medical-equipment and services industry, which criminals have targeted because it's easy to obtain Medicare-provider credentials, is doing its part to stop fraud. The industry insists on accreditation and other means of raising the bar for entry into Medicare as a provider of equipment and services.
However, some might conclude from the Sentinel's editorial that the decision by Congress to delay the controversial competitive-bidding program in order to reform and improve it was an effort by the industry to postpone or water down fraud prevention.

That is outrageous. Medicare fraud hurts the overwhelming majority of law-abiding home-medical-equipment providers who carefully comply with the crushing volume of Medicare paperwork and the dramatically declining reimbursement rates. The paperwork and declining reimbursement rates are making it harder and harder to provide the level of service that elderly and disabled home-care patients need.

When Congress recently enacted the Medicare Improvements for Patients and Providers Act of 2008, it strengthened the anti-fraud measures for the home-medical-equipment sector, and it closed a loophole that would have allowed unaccredited providers to serve Medicare patients. The Sentinel's editorial also failed to point out that the industry agreed to another large reimbursement cut in order to save taxpayers the more-than $1 billion they would have saved had the flawed bidding program gone forward.

There are many more steps that need to be taken to prevent fraud. The American Association for Homecare is developing an aggressive, comprehensive plan that it will share with concerned lawmakers such as Sen. Mel Martinez and regulators at CMS to prevent fraud.

It's important to avoid smearing the home-care sector in order to draw attention to the criminals who have been allowed to abuse Medicare.

The ultimate victims are Medicare beneficiaries and taxpayers who benefit from high-quality, cost-effective medical equipment and services provided in the comfort of the home rather than in more-expensive institutional settings. Fraud steals away resources that seniors and people with disabilities need. Lawmakers and regulators respond by punishing the entire home community.

Homecare is part of the solution to the Medicare crisis; it's not the problem. Lawmakers, regulators and the media should keep that in mind.

Tyler J. Wilson is president of the American Association for Homecare in Arlington, Va.

To view the Orlando Sentinel version please visit:,0,1327223.story