After years of poor enforcement of anti-fraud mechanisms in Medicare, it's no surprise that Congress, regulators and the states are sharpening their focus on stopping fraud. The HME sector has seen additional enrollment requirements and more widespread audits as a result (see "Onerous Audits").
Also, a provision in the new health care law enacted in March requires Medicare providers to adopt a compliance plan as a condition of enrollment. While the Department of Health and Human Services has not created the new regulations for these compliance plans, it's a good bet that HME will be among the first sectors to see new requirements.
Fortunately, a task force of American Association for Homecare members has been working for many months to develop a new, expanded Code of Business Ethics for its members, which may help meet the compliance and ethics requirements that will emerge. The foundation to any compliance plan is a comprehensive code of ethics.
Policymakers appreciate voluntary efforts by associations to take the initiative to develop anti-fraud and abuse recommendations for their sectors. AAHomecare's Code of Business Ethics was developed to ensure that high standards are met by home care providers, and to demonstrate our commitment to honest and transparent business practices. Companies voluntarily adopting this code will help defend the integrity of the entire sector.
The code incorporates current guidance and compliance standards as outlined by the Patient Protection and Affordable Care Act, as well as other regulatory and legal requirements relevant to home medical equipment companies. The new health reform law includes numerous compliance and ethics provisions, such as refunding overpayments within 60 days of the date they are identified, meeting a surety bond threshold commensurate with the provider's Medicare billings and expansion of RAC audits to Medicaid.
The AAHomecare Board of Directors realized the need to update the association's existing code to better reflect current laws, rules, regulations and official government guidance pertaining to the daily operations of HME providers.
The Board also felt the need to provide AAHomecare members with a clear understanding of the association's expectations. The new Code of Business Ethics will provide the Board with definitive criteria for evaluating action to be taken if a member is formally sanctioned by a regulatory body. By adopting the code, providers agree to promote and encourage ethical business practices in all of their interactions using the following core principles to guide conduct:
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Comply with applicable federal, state, and local laws and regulations, and
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Promote and encourage conduct that builds trust between HME providers, patients, referral sources and private and public sector payers.
The major sections of the AAHomecare revised code address principles to guide interactions with patients and caregivers, interactions with payers, interactions with referral sources and interactions with vendors.
AAHomecare and its members have worked with Congress and CMS to reinforce ethical business practices and socially responsible conduct by providers. This new code is designed to help the HME sector advance these efforts, and we will urge members to adopt the code.
Home medical equipment companies provide effective, essential products and services to millions of seniors and people with disabilities who require medical and therapeutic assistance. Adoption of this Code of Business Ethics should help providers preserve their hard-earned respect and credibility while ensuring that they are complying with regulations and laws.
You can review the revised code at www.aahomecare.org/CodeofEthics.
Read more AAHomecare Update columns.
Tyler J. Wilson is president and CEO of the American Association for Homecare, headquartered in Arlington, Va. You can reach him at tylerw@aahomecare.org. For more information on critical home care issues, visit the association's Web site at www.aahomecare.org.
