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American Association for Homecare Applauds Efforts to Eliminate Fraud in Medicare
Date:4/4/2012

The NSC should issue a provisional, non-permanent supplier number to new HME providers for a six-month trial period.  After six months of demonstrated compliance, the provider would receive a "regular" supplier number.

Status: H.R. 4872, the reconciliation bill passed along with ACA, contains a requirement in Sec. 1305 for a 90-day period of enhanced oversight for initial claims of HME providers. It requires a 90-day period to withhold payment and conduct enhanced oversight in cases where the HHS Secretary identifies a significant risk of fraud.

6.      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. 

Status: In 2010, CMS created a new Center for Program Integrity, which serves as the focal point for fraud and abuse activities for national and state-level Medicare, Medicaid, and CHIP program integrity activities.

7.      Ensure Proper Federal Funding for Fraud Prevention. Increase federal funding to ensure that the NSC completes site inspection and other anti-fraud measures.

Status: Anti-fraud efforts by Medicare and the Department of Justice have dramatically expanded and accelerated.  Congress has granted increased funding for CMS program integrity activities many times over the past three years.

8.      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. 

Status: The Durable Medical Equipment Medicare Administrative Contractors (DME MACs) now conduct post-payment audits.

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SOURCE American Association for Homecare
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