Friday, October 31, 2008

Candidates Views on Homecare

This historic election and the past year of policy changes related to homecare has prompted many within the HME community to ask which candidates and parties will be friendlier toward the durable medical equipment sector. The American Association for Homecare doesn’t endorse candidates, but we do work closely with and contribute to both Democrats and Republicans because HME issues are not usually partisan.

To help in your research, AAHomecare has gleaned information from both of the presidential candidates’ websites, the debates, and from the Kaiser Health Foundations 2008 Presidential Candidates Comparison website (

Both Senators consider homecare to be important and want to strengthen long term care policies. Barack Obama’s website state’s he supports the Community Choice Act of 2007 which would allow Americans with significant disabilities the choice of living in their community rather than having to live in a nursing home or other institution. He also supports Community Living Assistance Services and Supports (CLASS) Act which creates a voluntary budget-neutral national insurance program to assist adults with functional disabilities, allowing them to remain independent and in their communities. During the Republican ABC-Facebook debates which took place early in January, in Manchester, NH, John McCain advocated for home healthcare: “We need incentives for home healthcare as opposed to long term care. In my state of Arizona we adopted a proposal which incentivizes health care providers to keep people in home health care settings. It’s dramatically less expensive than long term care. In Arizona we have one half the numbers of people per capita in long term care facilities as the state of Pennsylvania. Incentives to keep cost down…there are no incentives in the system today.”

Both have made statements on Medicare fraud as well. Obama says he would empower the HHS Inspector General to fight fraud, implement anti-fraud measures in CMS contracting, expand the scope of Medicare and Medicaid audits, strengthen the federal False Claims Act, encourage states to go after fraud, and increase funding for Justice Department prosecutors and FBI agents to fight fraud. McCain simply states he advocates a zero tolerance policy towards Medicare fraud.

This is an important election year for congressional seats as well. Homecare has very strong champions in both political parties and we encourage DME providers to introduce themselves to the candidates and make sure new members of the Senate and House understand the value of homecare to their local communities. This is particularly important since most of the homecare policy has come out of Congress (not necessarily the White House) over the years.

AAHomecare encourages you to read both candidates healthcare plans and pay close attention to the congressional races. And don’t forget to vote on November 4!

Monday, October 27, 2008

Thirteen Recommendations for Eliminating Medicare Fraud

Tough new steps must be taken to prevent fraud and abuse in Medicare. The American Association for Homecare announced 13 specific recommendations that could eliminate most of the Medicare fraud attributed to the home medical equipment (HME) sector. The Association has been working with Congress and regulators over the past year to adopt tougher, more effective measures to combat Medicare fraud.

The specific recommendations made by the American Association for Homecare include:

Mandate Site Inspections for All New Home Medical Equipment Providers
A July 2008 GAO report underscored the need for CMS to ensure that its contractors are conducting effective site inspections for all new applicants for a Medicare supplier number.

Require Site Inspections for All HME Provider Renewals
All renewal applications should require an in-person visit by the National Supplier Clearinghouse (NSC), the contractor that CMS uses to ensure integrity in the Medicare program.

Improve Validation of New Homecare Providers
Additional validation of new providers should be included in a comprehensive and effective application process for obtaining a Medicare supplier number.

Require Two Additional Random, Unannounced Site Visits for All New Providers
Two unannounced site visits should be conducted by NSC during the first year of operation for new HME providers.

Require a Six-Month Trial Period for New Providers
The NSC should issue a provisional, non-permanent supplier number to new suppliers for a six-month trial period. After six months of demonstrated compliance, the provider would receive a “regular” supplier number.

Establish an Anti-Fraud Office at Medicare
CMS should establish an office with the sole mandate of coordinating detection and deterrence of fraud and improper payments across the Medicare and Medicaid programs.

Ensure Proper Federal Funding for Fraud Prevention
Increase federal funding to ensure that NSC completes site inspection and other anti-fraud measures.

Require Post-Payment Audit Reviews for All New Providers
Medicare’s program safeguard contractors should conduct post-payment sample reviews for six months worth of claims submitted to Medicare by new providers.

Conduct Real-Time Claims Analysis and a Refocus on Audit Resources
Medicare must analyze billings of new and existing providers in real time to identify aberrant billing patterns more quickly.

Ensure All Providers Are Qualified to Offer the Services They Bill
A cross-check system within Medicare databases should ensure that homecare providers are qualified and accredited for the specific equipment and services for which they are billing.

Establish Due Process Procedures for Suppliers
CMS should develop written due process procedures for the Medicare supplier number process, including issuance, denial and revocation of the Medicare supplier number. The procedures must include, for example, an administrative appeals process and timelines.

Increase Penalties and Fines for Fraud
Congress should establish more severe penalties for instances of buying or stealing beneficiaries’ Medicare numbers or physicians’ provider numbers that may be used to defraud the government.

Establish More Rigorous Quality Standards
Ensure that all accrediting bodies are applying the same set of rigorous standards and degree of inspection to their clients.

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