Thursday, April 23, 2009

AAHomecare Offers Senators an Aggressive, Detailed Proposal to Stop Medicare Fraud

At a Senate hearing yesterday, the American Association for Homecare submitted a statement and issued a press release outlining the Association’s 13-point plan to stop fraud in Medicare. The statement reads, “Our legislative action plan is designed to protect these patients and their families—as well as the American taxpayers—by stopping fraud and abuse in the Medicare system before it can start. The plan targets fraud and abuse at the source through proposed policies that will ensure that providers who participate in Medicare are responsible, legitimate businesses and those disreputable actors are locked out of the system and prevented from abusing the public trust.”

The AAHomecare statement also said, “It is important to note that the American Association for Homecare welcomes a full and thorough review of reimbursement policies for durable medical equipment to ensure that Medicare payments reflect the true costs of providing home medical care to beneficiaries.” (See Newsroom at to view the full statement.)

Both Senators and government witnesses discussed steps to reduce waste and fraud in the durable medical equipment sector, unfortunately including the use of the “competitive” bidding program as an anti-fraud tool and a panacea for Medicare reform.

The hearing was conducted by the Senate Committee on Homeland Security and Governmental Affairs Subcommittee on Federal Financial Management, Government Information, Federal Services, and International Security.

The Centers for Medicare and Medicaid Services (CMS) testified that “CMS is pursuing a ‘stop-gap program’ to focus on Medicare fraud in seven high-risk areas across the country where CMS is increasing our oversight of the highest paid DMEPOS suppliers and the highest billed DMEPOS equipment and supplies. The ‘stop-gap program’ increases pre-payment reviews of medical equipment suppliers and will also single out the highest-billed claims–continuous positive airway pressure (CPAP) devices, oxygen equipment, glucose monitors and test strips, and power wheelchairs…. The plan toughens the background checks on new suppliers and increases scrutiny on the highest ordering physicians and the highest utilizing beneficiaries.”

Both the hearing and the OIG report underscore the sorry state of Medicare fraud prevention in the United States, which has had a tragic, adverse impact on the vast majority of home medical equipment providers who fully comply with the law and that provide high quality services to seniors and people with disabilities who require medical equipment and care.


Anonymous said...

This is one reason I don't join AAHomecare. They are not protecting the DME industry as a whole. This 13 step proposal is a redundancy of processes that reinforces the placing of CMS as an autonomous decision making authority. Doesn't AAHomecare understand (much less address) the fact that the root of all Medicare fraud is with the prescribing entity? The majority of providers don't arbitrarily send equipment without an order. Who writes the order? A physician thats who! Whether they have a direct vested relationship with a DME provider or not, they are the ones who should be responsible and held accountable. A DME provider has the responsibility of establishing if the order meets medical necessity guidelines! The last thing DME needs now are more rules and regulations on the last one providing service in line. No one else has to go through accreditation! No one else has to monitor patient behavior following service! No one else has to take on the complete responsiblity and the complete wrath of CMS if an established procedure or notated item isn't met and undercovered by these site visits! Has AAHomecare ever gone through a site visit? All it takes is one bad day for a NSC inspector to find one thing wrong and basically shut down the whole company. This is another publicized statement that gives CMS the opportunity to shut down smaller providers. CMS is only going to attack the larger firms for the sake of a imposing a fine or expecting return or imbursements. All these comments do is make it easier for CMS to say the smaller provider can't handle the burden of the responsibility or afford the penalties when they are imposed. As we all know, it is the smaller provider that plays by the rules and the mid size to large corporations that manipulate fraud within the industry! Give us a break AAHomecare and talk to providers other than those who pay your dues as a member!!!

Unknown said...

Dear Anonymous,
I agree with all you said and have more to add The Government&(CMS) is doing what they did to dme providers now to Home Health Agencies. We are now being forced to become certifed and accrediated. Not that I think this is a bad thing but small agencies like mine are struggling with the cost involed in doing this.I went into this business to provide quality professional care for my patients but at this point in time I am getting ready to close my doors as I can no longer afford to keep in line with the cost of the changes. I read somewhere that the goverment did a study and the only cost to the provider is finical statements! I dont know what planet he is on but he obviously didnt take into account the fees involved in obtaining that accredation status such as at least 6400.00 for the survey.I did some figuring and it will cost our agency about 60.000 to get in bed with the government. I guess its a drop in the bucket when you here everything talked about in trillons. But is to much for those of us that try to run small Personalized Quality Home Health agencies.This is not to mention what the insurance companies do to providers of Home Health Care,One of the largest insurance companies has stolen between 70,000 & 80,000 from us.Any one have any ideas how we can recoup that money. Maybe its just me but I feel very alone and even my freedoms to provide care to those who so desparatly need it is being jepordized.I am sure there are fradulant companies out there and they are the ones lining the pockets of the politicians,not the small agencies.