Editor's Inbox

HME Providers “Set Up”To Take Fraud Fall

There is nothing competitive about competitive bidding. It is just a tool for CMS to eliminate providers, fix prices and control fraud and abuse.

Over the years, I have noticed that there seems to be an increase in the number of fraud cases uncovered by the FBI and OIG when there is some legislative change in the works. It is like they need to prove to everyone that what they are about to do is needed: “See! Look at the fraud! Now, take the punishment!” Interesting, isn't it?

The real rub of all of this is that the system is set up to allow an investigation of any one of us to result in an indictment. The paperwork burden required to prove medical necessity is unattainable. I venture to say that there is a fraud case just waiting to be discovered in every single file cabinet in every single HME company. We have all been set up to take a fall.

The real need is for this industry to prove to Congress that fraud is not the problem, and to expose the system for what it has really done to us.
— Jim Highsmith, owner, Softcare/US Health for Homecare, Inc., Griffin, Ga.

Drugmakers Should Compete for Medicare Business

I wrote [lawmakers] and told them to consider alternatives to the Medicare-reform bill. We could have Medicare Part A and B, then add [another part], which would manage drug benefits. [We should] force drug companies who are not in the game to compete for drug contracts … Instead, in order to pay for a leaner drug plan, our industry may have to take cuts to keep us all in business to really compete.

Competitive bidding is not really competition. The company that won [the Medicaid oxygen] contract in Utah has a difficult time meeting the demand.

Our company has been called and begged to help a patient on oxygen get home. Patients are forced to stay an extra night in the hospital because the company cannot get there in a reasonable timeframe. Who pays for that extra night in the hospital? The patient suffers, and Medicaid pays the bill.
— Darren Nord, RCP, CEO, Advanced Care Home Medical and Oxygen, Inc., Salt Lake City

Editor's Note: Utah's Medicaid program competitively bids its oxygen-only business.

Yea or Nay?

Please post a list of the members of the House of Representatives and the Senate and the way they voted [on the Medicare-reform bill]. This list should be used as a starting point for future [lobbying] efforts.
Kenneth R. Suter, president and CEO, Family Respiratory and Medical Supply Corp., Baltimore