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

. 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
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    SOURCE American Association for Homecare
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