WASHINGTON--The HHS Office of Inspector General issued a report Friday on south Florida HME providers based on results of unannounced visits to home care companies in Miami-Dade, Broward, and Palm Beach counties. The counties were targeted for review based on previous allegations of supplier noncompliance with Medicare standards.

Working in collaboration with CMS and the National Supplier Clearinghouse, the OIG inspected 1,581 businesses to assess their compliance with five specific requirements, which state that suppliers must: 1) maintain a physical facility; 2) be open and staffed during business hours; 3) have a visible sign; 4) post hours of operation; and 5) maintain listed telephone numbers.

During the site visits, OIG found that 45 percent of DMEPOS suppliers in the three south Florida counties did not comply with at least one of the five standards reviewed. Thirty-one percent of suppliers did not comply with the first two requirements of maintaining a facility at the business addresses that they provided to Medicare and being open for business during posted hours. Another 14 percent were open but failed to meet at least one of the three remaining requirements that OIG reviewed.

"It is clear that Medicare continues to be highly vulnerable to DMEPOS fraud and abuse," said Inspector General Daniel Levinson. "It is vital that we protect Medicare beneficiaries from unscrupulous suppliers who are gaming the system at the expense of our nation's seniors and taxpayers. Our colleagues at CMS share our goal of ensuring program integrity, and I am pleased that they have agreed with many of our recommendations."

Based on the report findings, the OIG recommended that CMS strengthen the supplier enrollment process to ensure that suppliers meet the Medicare standards through several actions, including:

--conducting more unannounced site visits and out-of-cycle inspections;
--performing more rigorous background checks of applicants;
--increasing the prepayment review of DMEPOS claims; and
--deactivating the Medicare billing numbers of suppliers that have been inactive for a 90-day period.

In a separate report released at the same time, the OIG documented the results of out-of-cycle visits to 169 DMEPOS suppliers not located in Florida. "Through our out-of-cycle site visits, we found that 10 of the 169 DMEPOS suppliers did not physically exist," according to the report, which noted that an additional six existed at their stated business addresses but were closed during posted hours of operation.

"The 10 absent DMEPOS suppliers billed Medicare almost $393,000 in the two months after we had determined that they were absent," the report said. "Of the nearly $393,000 in submitted claims, the suppliers received almost $197,000 in reimbursements as of Dec. 31, 2005."

The six suppliers that were closed during business hours collectively billed Medicare almost $102,000 in the two months after OIG discovered that they were closed, and received almost $52,000 in reimbursements as of Dec. 31, 2005.

According to the OIG, its findings suggest that out-of-cycle visits targeting DMEPOS suppliers "may be warranted in other areas of the country."

To view the report on south Florida suppliers, click here.

To view the report on suppliers in other areas, click here.

Want to use this article? Click here for options!
© 2007 Penton Media, Inc.