MIAMI--Some 200 HME providers in the Miami area have received letters from the National Supplier Clearinghouse suspending their provider numbers--and many, if not all, are without appropriate cause, attorneys and providers said.
"As of right now, the numbers are revoked and [CMS is] not doing claims," said Neil Caesar of Greenville, S.C.-based Health Law Center. "They also have put every claim [for those numbers] that was in the pipeline on 100 percent audit."
Those actions have not only crippled many providers' businesses, they have put beneficiaries at risk, said Javier Talamo of Kravitz & Talamo, Hialeah, Fla. "The providers are going broke as bureaucracy grinds to a halt. If you suspend 200 providers, you risk thousands of patients having no providers."
Talamo and Caesar said the letters, dated Dec. 18 and Dec. 20, were sent out over the holiday season.
"In the letters, [the NSC] says they visited the suppliers multiple times and the providers were not at their locations. Therefore, they are in violation of all 21 standards," said Talamo, who has about 30 clients who have received such letters.
The Dec. 18 letters do not allow suppliers to put forth a corrective action plan, Talamo said, while the letters dated Dec. 20 do.
Still, said Caesar, while those letters stated providers had 15 days before the provider number would be pulled ("even though the manual says 30 days from the postmark"), the NSC didn't wait 15 days from the date of the letter before suspending the numbers.
Neither of the letters says when the visits were made, Talamo said. He added that providers did not find any notices posted on their doors indicating a visit. Caesar said he doubts that any more than a single visit was made, if that.
Talamo said that "Medicare may not have gone to some locations and, without a doubt, did not go to all of them and did not go multiple times. If that is proven to be true, it is scandalous. It is a national scandal for NSC and Medicare."
Another big problem is the erroneous charge against the providers, the attorneys said. Both letters cite a single statute that providers are said to have violated, but it is not applicable to the HME industry, according to Caesar and Talamo.
"The statute--42CFR Section 405.535--refers to mammography services," said Talamo. "I have written Medicare directly and spoken to their office and requested a rescission of the letter based on two things: You have providers who are treated differently, and the statute they use is indefensible. I cannot have a hearing on mammography."
As of Friday, Talamo said, he had not yet heard back from CMS.
Caesar, who also represents clients who have received letters, said he has gotten only "scripted answers" from CMS and the NSC. While the rule has been around for years that CMS is to have a hearing within a week for a provider in jeopardy of losing its provider number, "they claimed they were swamped because of the holidays," Caesar said, and no hearings have been set.
"They are not even adhering to their own rules," he said. "They mishandled this, and in a way that seems totally indifferent to following the rules."
Talamo agreed. "If Medicare expects providers to follow the rules, they should follow the rules."
News of the rescinded provider numbers spread like wildfire through the Florida HME community.
"Isn't this the United States? We are supposed to be innocent until proven guilty, and that's not what is going on here," said Joan Cross, president of C&C Homecare in Bradenton, Fla. Cross, current president of the NSC board and former president of the Florida Association of Medical Equipment Suppliers, said most providers could not afford to defend themselves against such actions.
Raul Lopez, director of operations for Bayshore Dura Medical, Miami Lakes, Fla., and current president of FAMES, said he is concerned that in their zeal to derail fraudulent activities, CMS is being too aggressive.
Lopez noted that one provider contacted FAMES when his company was at risk of losing its provider number because its 21 standards listed "HCFA," the predecessor of CMS. But because the official CMS document also said HCFA, the number was not rescinded.
"I would like to know how [the government is] going into these companies. Are they being super aggressive? Are they allowing for explanation?" Lopez asked. "I would hope that they are not being super aggressive with things that are small or just clerical."
For his part, Talamo warned that as goes Miami, so goes the rest of the nation. "Just remember that these are the people that are going to be running competitive bidding," he said.
"This is Miami's problem now, but if you are in [an MSA for
competitive bidding], it will soon be your problem as
well."
