We all realize federal legislators and regulators seem to think this industry is full of crooks, and that perception colors much of how HME providers are treated by Congress and CMS. Operation Wheeler Dealer, the Medicare Fraud Strike Force, the surety bond requirement and, last month, an announcement by HHS Secretary Kathleen Sebelius and U.S. Attorney General Eric Holder that the current anti-fraud operation in South Florida and Los Angeles will be expanded to Detroit and Houston — we get it.
Even so, it's jolting to hear directly from a former HHS-CMS staff member that's how the industry is perceived. But that's exactly what Thomas Barker told a room full of AAHomecare members during the association's Washington Legislative Conference.
“There's just a perception that it's an unethical business,” said Barker, who served as acting general counsel and policy advisor under HHS Secretary Michael Leavitt (meaning he was in charge of 450 attorneys who gave legal and policy advice to Leavitt, as well as to the administrator of CMS and the commissioner of the FDA).
CMS thinks HME providers are overpaid, dislikes direct-to-consumer marketing and hears countless stories of “abusive transactions,” Barker said. Those opinions only got worse, he continued, after Leavitt personally toured one South Florida building that supposedly housed a number of HME companies. What he found instead were locked doors and empty offices. Barker should know; he was along on the 2006 excursion.
Even though it was the government's own gatekeeper that gave those sham companies supplier numbers, that field trip made an impression that has stuck.
What can the industry do to change the bad rap? “You're doing it,” Barker said, referring to the fact that more than 250 providers and other advocates were in the nation's capital to talk to their legislators about HME concerns. (Of course there should have been more, but I'll leave that for another column.)
Barker's specific advice: “Send a message that the vast majority of HME suppliers are ethical, honest businessmen and women who are trying to do the right thing for Medicare beneficiaries … Stress that point over and over and over again,” he said. “Focus on the value that HME brings to the health care system. At the end of the day, keeping someone in a properly functioning power wheelchair or hospital bed … produces savings to the health care system and it can create value. Making that point again and again cannot be overemphasized.”
Good suggestions, I agree. After all, you're the guys wearing the white hats, and working to shed the industry's besmirched reputation is worth pursuing. But it's definitely a frustrating effort. When one audience member asked why the same government contractor — the one that let in all those crooked companies — had been given that contract again, Barker replied, “I can't explain why or how that happened.”
Maybe we should consider this suggestion from Delaware provider Richard Swearer. “Just a thought,” he wrote in. “How about the HME industry launch a campaign to require all elected officials to post a surety bond since there have been cases in the past of elected officials committing fraud.
“Since there are isolated instances of dishonest elected officials, that means all existing elected officials are dishonest. Kind of the same logic CMS is using on our industry.”
