Navigation Links
Medicare's Audit Process Hampers Access to At-Home Care

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, we believe that this shows a breakdown in the system.  The American Association for Homecare is working to inject common sense and accountability into the audit process and address the complexity of Medicare at-home coverage policies to ensure that beneficiaries are receiving medically necessary items and services.  Both these steps are necessary to make the program work better for all stakeholders," said Wilson.  

Current audit standards employed by Medicare contractors are having the following unintended consequences:

  • Data regarding fraud is being distorted;
  • Eligible Medicare beneficiaries are not receiving medically necessary and covered benefits;
  • Auditors for CMS misinterpret and then misapply Medicare rules and regulations, sometimes on a retroactive basis, leading to inaccurate error-rate data;
  • Legitimate providers furnishing medically necessary items and services are being hurt by unjustified monetary recoupments; and
  • CMS will not be able to achieve the Administration's goal of reducing the error rate until it modifies its current audit policies.

The American Association for Homecare represents durable medical equipment providers, manufacturers, and other organizations in the homecare community. Members serve the medical needs of millions of Americans who require oxygen equipment and therapy, mobility assistive technologies, medical supplies, inhalation drug therapy, home infusion, and other medical equipment and services in their homes. The Association's members operate more than 3,000 homecare locations in all 50 states. Visit

SOURCE American Association for Homecare
Copyright©2010 PR Newswire.
All rights reserved

Related medicine technology :

1. American Scientific Resources Inc. Discloses Audited Financials for 2007 and 2008
2. LifeVantage Announces Preliminary Unaudited First Quarter Revenue
3. ISTA Pharmaceuticals Announces Preliminary, Unaudited Revenue of $110.6 Million in 2009
4. LifeVantage Announces Unaudited First Quarter Fiscal 2010 Financial and Operating Results
5. ReSearch Pharmaceutical Services, Inc. Unaudited Quarterly Report for the Period Ended September 30, 2009
6. Simcere Pharmaceutical Group to Announce Fourth Quarter and Fiscal Year 2009 Unaudited Financial Results on Tuesday, March 16, 2010
7. Simcere Pharmaceutical Group Reports Preliminary Unaudited First Quarter 2010 Results
8. Abviva Engages W.T. Uniack & Co. As Independent Auditor
9. eDataAudit Receives Approval from the American Board of Radiology
10. China BCT Announces Auditor Change Within PKF Network
11. OmniComm Systems Announces Auditor Change
Post Your Comments:
(Date:6/23/2016)... 23, 2016 Research and Markets ... Market by Type (Organic Chemical (Sugar, Petrochemical, Glycerin), Inorganic ... Coating, Parenteral) - Global Forecast to 2021" report ... The global pharmaceutical excipients market is projected to ... of 6.1% in the forecast period 2016 to 2021. ...
(Date:6/23/2016)... -- Roche (SIX: RO, ROG; OTCQX: RHHBY) announced that ... PCT (procalcitonin) assay as a dedicated testing solution for ... clearance, Roche is the first IVD company in the ... risk assessment and management. PCT is a ... in blood can aid clinicians in assessing the risk ...
(Date:6/23/2016)... ANGELES , June 23, 2016 ... CAPR ), a biotechnology company focused ... therapeutics, today announced that patient enrollment in its ... in Duchenne) has exceeded 50% of its 24-patient ... enrollment in the third quarter of 2016, and ...
Breaking Medicine Technology:
(Date:6/26/2016)... Clarkston, Michigan (PRWEB) , ... June 26, 2016 ... ... respect to fertility once they have been diagnosed with endometriosis. These women need ... but they also require a comprehensive approach that can help for preservation of ...
(Date:6/25/2016)... ... June 25, 2016 , ... "With 30 hand-drawn hand gesture animations, FCPX ... Austin - CEO of Pixel Film Studios. , ProHand Cartoon’s package transforms over ... Cut Pro X . Simply select a ProHand generator and drag it above media ...
(Date:6/25/2016)... ... , ... On Friday, June 10, Van Mitchell, Secretary of the Maryland Department ... in recognition of their exemplary accomplishments in worksite health promotion. , The Wellness at ... Wellness Symposium at the BWI Marriott in Linthicum Heights. iHire was one of 42 ...
(Date:6/24/2016)... ... ... June 19, 2016 is World Sickle Cell Observance Day. In an effort ... holistic treatments, Serenity Recovery Center of Marne, Michigan, has issued a pain ... Disease (SCD) is a disorder of the red blood cells, which can cause episodes ...
(Date:6/24/2016)... (PRWEB) , ... June 24, 2016 , ... ... now offering micro-osteoperforation for accelerated orthodontic treatment. Dr. Cheng has extensive experience with ... Damon brackets , AcceleDent, and accelerated osteogenic orthodontics. , Micro-osteoperforation is a ...
Breaking Medicine News(10 mins):