A front-page story in the September 20 USA Today reports on proposed regulations to crack down on Medicare and Medicaid fraud. The paper quotes Michael Reinemer of the American Association for Homecare saying, “Nobody is more anxious to stop fraud than we are because the legitimate providers are the ones that suffer.”
The proposed rule is open for comments, and final regulations will be published at the end of the year. To review the proposed rule, visit www.ofr.gov/inspection.aspx. Click here to read the full USA Today article.
Members of the American Association for Homecare have zero tolerance for fraud. The Association has been frustrated that it has taken so many years for Medicare to deal effectively with the fraud problem at the front-end rather than relying on the pay-and-chase system of catching criminals after theft has occurred.
AAHomecare introduced an aggressive 13-point anti-fraud legislative action plan in 2009, parts of which were adopted in legislation proposed by Congress and enacted into law. See www.aahomecare.org/stopfraud. The 13-point plan includes proposals such as real-time claim audits, higher penalties for fraud, more federal funding for anti-fraud programs, and a dedicated anti-fraud office at the federal Centers for Medicare and Medicaid Services (CMS), part of HHS.
Two important anti-fraud measures in federal law took effect a year ago. One is an accreditation requirement: all providers of home medical equipment in Medicare must be accredited by an agency approved by CMS. This is a lengthy, expensive process that should have had a significant impact on fraudulent activity related to home medical equipment, or durable medical equipment. Second, home medical equipment providers are required to post a surety bond.
So a critical question is: What effect have those measures had on criminal activity? Have those measures had an impact on fraud numbers? Often, federal officials recite old numbers related to activity long before those two measures took effect. Now it’s important to review more current data, rather than out-of-date figures from 2007 or 2008. Also, discussions about fraud often conflate or blur separate issues such the “competitive” bidding program (a price-setting mechanism) or improper payments, which is not the same as fraud. Those distinctions need to be understood better by policymakers and the public.