AAHomecare Drafts Proposal to Root Out Fraud and Abuse

ARLINGTON, Va.--In a proactive move to provide CMS and federal legislators alike with concrete strategies for stemming fraud and abuse in the home medical equipment industry, the American Association for Homecare is crafting a plan that could be presented by the end of the year.

Among its possible components are increased scrutiny of new HME providers, real–time claims analysis, accreditation and unannounced site visits.

“We are still in the formative stages of this proposal, and we are working with our members to collect best practices,” Walt Gorski, vice president of government affairs for AAHomecare, said last week. “HME providers, we believe, are the most effective at determining these policies, since they are on the ground and know what works, what is a hassle factor and what doesn’t work.”

Already, AAHomecare has, in the last year, offered input on two separate anti-fraud efforts, including the proposed implementation of a surety bond requirement for providers and the draft of the Seniors and Taxpayers Obligation Protection Act of 2008 (S. 3164), or STOP Act. The latter requires the Secretary of Health and Human Services to change the identifier used to identify Medicare beneficiaries under the program.

The need for the industry to step forward with an anti-fraud plan has, however, become increasingly obvious in the face of derogatory reports that are appearing with alarming frequency in mainstream media such as the Wall Street Journal and the New York Times, Gorski and others said.

“The industry cannot leave its future in the hands of others,” said Gorski. “Recent reports highlighting improper behavior on the DMEPOS benefit validate much of what the HME community has been saying for a very long time: CMS has not adequately policed the program and kept criminals from getting supplier numbers.

“Under no circumstance should Medicare provide a supplier number to a broom closet that includes a bucket of sand and a wrench,” he stated, referring to a government sweep that found hundreds of alleged providers in South Florida and elsewhere had given fraudulent addresses to Medicare. (See HomeCare Monday, July 9, 2007.)

Industry stakeholders roundly applauded the idea of the proposal, which will seek to stop fraud at the front end of the payment process rather than relying on the current “pay-and-chase” system, AAHomecare officials said.