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Medicare's Audit Process Hampers Access to At-Home Care
Date:7/5/2011

ARLINGTON, Va., July 5, 2011 /PRNewswire-USNewswire/ -- Over-reaching by federal audit contractors in Medicare is restricting the ability of legitimate providers to supply medically required care and equipment to patients.  The American Association for Homecare is working with policy makers to ensure that fraud prevention efforts are effective at stopping fraud without limiting access to care.

At a June fraud prevention summit conducted by the U.S. Department of Health and Human Services and the Justice Department, the administrator of the federal Centers for Medicare and Medicaid Services (CMS) admitted that audits designed to detect fraud are a "blunt instrument." After hearing several complaints from healthcare providers participating in the fraud prevention summit, another CMS official stated that federal officials will conduct an "audit audit" to ensure that audit contractors do not needlessly hamper legitimate providers.

"The current auditing strategy is expensive, inefficient, and distorts the Medicare claims error rate for at-home care products," said Tyler Wilson, president of the American Association for Homecare. "The burdensome process disrupts the service and care provided to patients in need of these at-home services and severely taxes providers' resources."

In 2008, the Medicare homecare claims error rate was approximately nine percent. However, in 2009 CMS adopted its new auditing criteria, which resulted in a claims error rate of 52 percent. In 2010, the claims error rate jumped to an astonishing 75 percent, incorrectly suggesting that three out of four Medicare claims for at-home equipment and services are paid improperly or are the result of fraud or abuse.

"When 75 percent of Medicare HME claims are considered to be improper,
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SOURCE American Association for Homecare
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