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American Association for Homecare Supports Expanded Federal Efforts by DOJ and HHS to Combat Medicare Fraud
Date:5/20/2009

ARLINGTON, Va., May 20 /PRNewswire-USNewswire/ -- The American Association for Homecare supports expanded anti-fraud efforts announced today by the U.S. Department of Justice (DOJ) and the Department of Health and Human Services (HHS) designed to curb fraud and abuse in Medicare. The two agencies outlined plans for expanding anti-fraud strike forces to Houston and Detroit and creating a new Health Care Fraud Prevention and Enforcement Action Team.

Even with the stepped-up DOJ-HHS effort, the American Association for Homecare believes more must be done to stop fraud and it continues to urge Congress and the Centers for Medicare and Medicaid Services (CMS) to adopt the 13 specific anti-fraud recommendations proposed by the Association in 2008, which could eliminate most of the fraud associated with home medical equipment (HME) payments.

Some of the Association's proposals were included in the Seniors and Taxpayers Obligation Protection (STOP) Act, S. 975, which the Association supports. However, Congress should adopt all 13 of the anti-fraud measures. A proactive solution is more effective than the "pay and chase" method and makes more sense than the endless cycle of unwarranted cuts to Medicare reimbursement for durable medical equipment. The 13-point plan targets the source of the problem.

"For a long time, the activities of criminals have tarnished the good name of honest providers of home medical equipment and services," said Tyler J. Wilson, president of the American Association for Homecare. "We support expanded and more effective government efforts to stamp out fraud."

The discussion about keeping criminals out of Medicare sometimes obscures several facts: home-based care is vastly more cost-effective than institutional care; durable medical equipment represents about 1.6 percent of Medicare spending; and spending growth in this sector is a mere 0.75 percent, according to federal National Health Expenditure data.

Specific Anti-Fraud and Abuse Recommendations:

The American Association for Homecare has proposed the following 13 specific recommendations:

  • 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 the 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 the 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.

CONTACTS: Michael Reinemer, 703-535-1881, michaelr@aahomecare.org; Tilly Gambill, 703-535-1896, tillyg@aahomecare.org.

The American Association for Homecare represents durable medical equipment providers, manufacturers, and other organizations in the homecare community. Members serve the medical needs of millions of Americans who require oxygen therapy, mobility assistive technologies, medical supplies, inhalation drug therapy, home infusion, and other medical equipment and services in their homes. Visit www.aahomecare.org/stopfraud.


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SOURCE American Association for Homecare
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