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Durable Medical Equipment Community Supports Tough Anti-Fraud Measures, Corrects Persistent Myths
Date:9/22/2010

iciaries they serve require clear, reasonable, consistent, and unambiguous guidance that does not change from auditor to auditor.

CMS and Its Private Contractors Have Failed in their Oversight of Supplier Enrollment

A number of reports have pointed to the low barrier to entry that has made home medical equipment vulnerable to criminal activity and fraud.  In south Florida, for example, the OIG conducted unannounced site visits to 1,581 providers and found that 31 percent of these providers did not maintain a physical facility or were not open and staffed during business hours.  In another analysis, the GAO found that a supplier number was granted to a broom closet.  

AAHomecare believes that CMS and its contractors have failed in their oversight responsibility.  It is CMS' responsibility to determine whether a supplier should be granted billing privileges.  CMS is required to conduct a site visit for any new supplier and upon renewal of the supplier number every three years.  If CMS were doing an adequate job, these egregious lapses would not have occurred.  Congress has also addressed this vulnerability by requiring mandatory accreditation and quality standards for all home medical equipment providers.  This should serve as a double check on CMS and raises the bar of entry and protect the Medicare program.  Finally, policymakers and the media focus on fraudulent activity that occurred prior to the implementation of enhanced screening tools in 2009.

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 suppl
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SOURCE American Association for Homecare
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