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Medicare Anti-Fraud Measures are Way Overdue, Says Durable Medical Equipment Industry
Date:1/8/2008

o was supposed to conduct an unannounced site visit at least once every three years in order for the supplier to have its supplier number renewed.

A site visit is supposed to be more than a perfunctory glance at a company's operations. An inspector conducting a site visit has a number of requirements that he or she should be looking for such as verifying delivery slips and checking to make sure there is a complaint file. The inspector should also be looking at the suppliers' patient files. An inspector would be able to spot forgeries.

CMS has the ability, through its private contractors, to monitor utilization data from claims. A spike in utilization for a specific DME item should trigger closer examination. Unfortunately, Medicare does not seem to do this on a regular basis and when they do, it may be a long period of time after the initial aberrations are seen.

Several questions should be asked of Medicare officials:

-- What is Medicare's accountability in the program's inability to prevent bad actors from obtaining a Medicare supplier number and the program's inability to identify billing irregularities?

-- Why has Medicare failed to protect taxpayer dollars by enforcing its current mandates?

-- How many fraudulent suppliers have been caught in their first year or are turned away when applying for a supplier number in Medicare?

Medicare and its private sector contractors must do a better job of insisting on standards and other up-front controls that will deny illegitimate operators any chance of taking advantage of the Medicare program.

The American Association for Homecare has been at the forefront of efforts to prevent fraud, which is why the homecare industry supports accreditation, quality standards, and other measures to help stem illegal activity. Medicare has failed to enforce critical up-front controls that would curb the opportunity for fly-by-night operators to rip off Medicare. <
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SOURCE American Association for Homecare
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