While the demonstration project in South Florida and Los Angeles should indeed help to reduce fraud and abuse, there are ways to make it even more effective.
CMS has publicly announced that its crackdown will unfold over a 30-90 day period, but wouldn’t that give the scam artists a window to accelerate electronic billing on the supplier numbers they already have?? Moreover, will it also give them time to relocate to other areas that are NOT part of the demonstration project? The program would be more effective if it was enacted immediately without giving these scam artists time to adjust. For example, CMS should consider making immediate site visits, and taking a more aggressive step of canceling supplier numbers suspected of being associated with shaky suppliers. Those businesses should be forced to prove they are legitimate.
Many company executives, including myself, have strongly advocated for years that mandatory accreditation for all suppliers would curtail fraud within the Medicare program. Our own reviews (which for the record are not nearly as sophisticated as the government investigations) have found "companies" billing the Medicare system for power mobility equipment while operating from addresses that were dry cleaners, vacant buildings, and garages. Congress has weighed in and has called for action. Last month, the Washington Post reported the third conviction from HHS’ special task force unit.
In most cases, senior citizens and people living with disabilities have been victims of these scams because they never received the products or services. Should the time ever come, most will not be able to receive a power wheelchair or scooter because government records show that they have already received one.
To be sure, if the fight against fraud is to be successful, the government must revise the system so that scam artists no longer have easy access to NSC billing numbers that open the door to Medicare reimbursements. CMS is now requiring accreditation in connection with the competitive bidding program, but that’s a process that will take years to be fully implemented.
What’s needed is mandatory accreditation for all suppliers before they can bill the Medicare program. This would force all suppliers to face a level of scrutiny that would weed out many of the fraudulent dealers and eliminate the longstanding pay and chase approach the government has used for years. Another benefit is that it would improve the credibility of the power wheelchair industry, and help ensure that Medicare beneficiaries receive quality service, as well as quality products. The days of criminals who pay doctors to write hundreds, if not thousands of phony power wheelchair prescriptions are numbered!
For almost five years now, I have been educating Congress on a number of ways to fight real fraud in the Medicare system. Some of those initiatives include mandatory third party accreditation, increased quality standards and increased, unannounced site visits. I am convinced that there was someone finally listening when I asked the question: how can a dry cleaner or empty building be billing the Medicare program? Can it really be that easy? Shouldn’t we be doing as much as we possibly can to a) protect our most frail population from these scam artists, b) protect the Medicare trust, and c) finally save the integrity of legitimate suppliers who are 100% committed to providing quality healthcare to Medicare beneficiaries?
The power mobility industry has been pushing for true, fraud measures for quite some time. It seems that for every step we take forward in gaining much deserved credibility, another scam artist makes the front page. Quite frankly…it’s time to put an end to this practice. In fact, the American Association for Homecare wrote an open letter to Congress entitled Greater Efforts Needed by Medicare to Combat Fraud applauding the recent efforts by CMS, but that more needed to be done.
Now, The Centers for Medicare and Medicaid Services (CMS) appears to be getting serious about fighting Medicare fraud associated with the power mobility benefit. The agency has recently shifted their focus from measures that restrict access to power wheelchairs and scooters to actually tracking down fraudulent suppliers and putting an end to costly scams that are costing the government millions of dollars.
In a July 2 press conference, Health and Human Services Secretary, Michael Leavitt announced an expansion of the Medicare Fraud Strike Force, a two-year effort designed to further protect Medicare beneficiaries from fraudulent suppliers. The power mobility industry applauds this new direction. Suppliers, manufacturers and Medicare beneficiaries still suffer from the series of regulatory changes — reimbursement cuts, new coding, competitive bidding and others — that were touted by CMS as tough action against fraud. But in most instances, the victims of these policies were legitimate suppliers and beneficiaries, not the scammers.
At least now, CMS has its sights on the right target: the fraudulent dealers. The demonstration project is aimed at South Florida and Los Angeles. Under the initiative, suppliers (about 2,700 in South Florida and 5,000 in LA) must reapply for their National Supplier Clearinghouse (NSC) supplier numbers; these numbers are required to bill the Medicare system. And, suppliers will need to be accredited and CMS will also conduct unannounced site visits.
This is attacking the problem at the source!
I’ll have Part II next time.