Enough Is Enough

Medicare fraud hurts beneficiaries by stealing resources. It hurts taxpayers whose dollars are wasted. And it hurts all of the law-abiding and well-intentioned HME professionals who carefully comply with the multitude of Medicare regulations and yet continue to provide high-quality services, supplies and equipment in spite of declining reimbursement.

That's why AAHomecare is working hard to stop fraud and protect the reputation of the home care community. For years, many in the home care sector have insisted on tougher up-front controls and screening mechanisms — such as mandatory accreditation — that will prevent criminals from infiltrating the Medicare program and tarnishing the good name of providers.

Only recently have government watchdog agencies pinpointed the depth of this program, which validates our long-held belief that CMS and its contractors have been slow and ineffective in deterring fraud.

The tide is turning, but too slowly. CMS will require mandatory accreditation by September 2009, decades after the association began calling for accreditation and five years after Congress instructed CMS to implement the policy.

CMS recently delayed the January 2009 accreditation deadline for HME providers in the 70 areas designated for round two of competitive bidding, a move that we publicly opposed.

We also opposed exempting physical therapists, occupational therapists, clinical social workers and physician assistants, among others, from the DMEPOS accreditation requirements. This means that of the 113,000 active Medicare supplier numbers that are allowed to bill for HME, only HME providers must become accredited. Our estimate is that about 70,000 entities with supplier numbers will not be required to become accredited.

This exemption policy is not the way to preserve quality of care for patients. We should level the playing field for everyone who provides home medical equipment, and no one should get a free pass. So the responsibility falls on us to work in Washington to ensure that effective fraud prevention and early detection measures are established and enforced.

Congress strengthened the anti-fraud measures for the HME sector in the recently enacted Medicare Improvements for Patients and Providers Act by establishing the firm September 2009 deadline for accreditation and by closing a loophole that would have allowed unaccredited providers to serve Medicare patients.