Washington Wit & Wisdom
Getting Rid of Fraud
As the new Democratic Congress began examining Medicare and Medicaid issues after the Bush administration unveiled its 2008 proposed budget, some ugly fraud and abuse stories were highlighted at House and Senate hearings held to examine issues in these programs. And yes, those stories included our HME industry, particularly the Miami area.
As an industry, we cannot afford to be the subject of any further smearing on Capitol Hill. The few friends and supporters we have will disappear, and our problems will be far greater than they are currently. So here's what I recommend that we, as an industry and as individual businesses, need to do.
We must first publicly declare that we are committed to working with the government to help eliminate fraud and abuse in the Medicare program. We must make it clear that any level of intentional fraud is unacceptable, and that we are outraged at the allegations regarding the level of fraud and abuse that appears to be occurring in the Miami area.
At the same time, it is important for policymakers to understand that Medicare's rules, regulations, requirements and paperwork associated with billing the program are extremely arduous. For example, rules and regulations change frequently, and often a seemingly minor change — such as the recent conversion from one DMEPOS Program Safeguard Contractor administrator to another — can result in a number of misunderstandings or misapplication of existing regulations.
Even a Government Accountability Office report last year acknowledged that a certain percentage of what it characterizes as “improper payments” actually result from honest mistakes, typographical errors or other administrative issues associated with billing rather than from intentional and overt fraud and abuse.
Another critical point for legislators is that the industry has for many years been asking CMS and Congress to require more stringent Medicare supplier standards to ensure that only legitimate entities are able to receive a supplier number and bill the Medicare program. We continue to believe that the current requirements, while generally stringent, can be strengthened in terms of both the way in which new provider numbers are granted by the National Supplier Clearinghouse and the subsequent pre- and post-payment audit sampling methods that are used to identify potential fraud and abuse.