Monday, June 20, 2011

Home Medical Equipment Sector Continues to Promote Tough Anti-Fraud Measures

Following the Philadelphia Health Care Fraud Prevention Summit on June 17, which is sponsored by the U.S. Department of Health and Human Services (HHS) and the U.S. Department of Justice, the American Association for Homecare released the following statement:

“The American Association for Homecare and its members have always had zero tolerance for fraud and will continue to work with federal officials to prevent fraud. In 2009, the American Association for Homecare proposed to Congress an aggressive 13-point Medicare Anti-Fraud Legislative Action Plan that includes tougher penalties for fraud, more site visits, and real-time claims audits to prevent fraud at the front-end of the process rather than relying on the ineffective pay-and-chase system. The majority of the Association’s recommendations have been adopted by Congress and the Centers for Medicare and Medicaid Services (CMS). However, we encourage Congress to adopt all of our proposals to ensure a comprehensive approach that directly shuts down avenues for Medicare fraud. A number of important new anti-fraud measures are now in place, which were long overdue. But Congress, CMS, and the HHS Office of Inspector General (OIG) should not impose unreasonable burdens on the existing, accredited home medical equipment providers. “Crooks, cheats, and con artists have no place in Medicare or healthcare in general,” said John Shirvinsky, executive director of the Pennsylvania Association of Medical Suppliers. “Unfortunately the CMS enforcement model has spent more time on punishing legitimate home medical equipment providers than eliminating the opportunity for bad actors to get into the Medicare system.” It’s important to point out that providers of home medical equipment must now be accredited by a deemed accrediting organization and they must also post a surety bond. These two requirements took effect in October 2009, and fraud associated with the home medical equipment sector has likely declined since then. We encourage federal officials to assess and report the rate of fraud since these requirements took effect. Spending in the home medical equipment sector represents less than 1.5 percent of total Medicare spending, and the HME proportion as well as the dollar amount in Medicare are falling. By any measure, any fraud or waste associated with home medical equipment sector can only represent a tiny fraction of total fraud, waste, or abuse in Medicare. The American Association for Homecare understands that lawmakers and regulators face the difficult challenge of reining in growing health care costs – and federal spending overall – which is why it is critical to note that home-based care is the most cost-effective setting for post-acute care. Congress must consider the aging U.S. population, the rising incidence of diabetes, COPD, and other chronic conditions, the high cost of treatment in hospitals and nursing facilities, and Americans’ clear preference for remaining safe and independent at home as they age. All of these factors argue for a stronger approach to providing homecare, not an erosion of the system.”

To see the 13-Point legislative plan, visit