CMS (Centers for Medicare & Medicaid Services) should be applauded for recently implementing mandatory accreditation that will provide closer inspection of suppliers who will be allowed to bid for contracts under the new competitive bidding process being implemented. While suppliers and manufacturers have various concerns about whether competitive bidding for power wheelchairs and scooters is going to be an effective and efficient process for delivering mobility equipment to Medicare beneficiaries, there is resounding support within the industry for mandatory accreditation. In fact, the industry has called for swifter implementation of this important safeguard than the government’s own timeline.
The industry, however, is concerned that the highly public CMS campaign to fight fraud is overshadowing a developing crisis for Medicare beneficiaries.
In 2007, a CMS forecast said that 243,000 Medicare beneficiaries would medically require a power wheelchair or scooter. But the Medicare power mobility benefit was utilized by only 170,000 beneficiaries, leaving more than 70,000 people who did not get the power wheelchairs or scooters they need to improve their mobility and quality of life.
We fear that new policies and regulations from reimbursement cuts to coverage policy and coding changes have caused many suppliers to go out of business or stop providing power mobility equipment. The result is that it becomes more difficult for Medicare beneficiaries to find suppliers to fill their prescriptions.
Competitive bidding is adding another new wrinkle, with an uncertain impact on suppliers. The industry supports CMS efforts to eliminate Medicare fraud, including new regulations that help achieve that goal. But we also need for the agency to stay aware of the impact and burdens that its policies can place on legitimate, law-abiding suppliers, and more importantly, Medicare beneficiaries. The most vulnerable people in our society deserve a Medicare process that works, and improves their quality of life.
At a recent congressional briefing, the Centers for Medicare & Medicaid Services (CMS), sharply criticized the Durable Medical Equipment industry, decrying that rampant fraud costs the Medicare system millions of dollars each year. While Medicare fraud certainly must be stopped, the context in which CMS discusses it and the root causes of the fraud need to be addressed.
For years now, CMS has repeatedly pointed the finger at “the industry,” particularly when discussing fraud related to power wheelchairs and scooters.
Let’s take a closer look. The power mobility industry is comprised of the manufacturers of power mobility equipment and the suppliers, businesses ranging from mom and pop operations to large companies. These suppliers navigate CMS’ ever-changing regulations and policies to deliver power wheelchairs and scooters to Medicare beneficiaries living with disabilities. The fraudulent operators are NOT part of the legitimate power mobility industry. They list their addresses as vacant buildings or storefronts, and move from place to place. They are not real businesses; they are crooks.
Consider this: When scam artists bilk investors in land scams, are they referred to as part of the legitimate real estate industry? No. If a car thief steals automobiles, strips the vehicles and is caught reselling the auto parts, is he referred to as part of the auto parts industry? Again the answer is a resounding, no. It shouldn’t be any different in the durable medical equipment business.
Unfortunately, by talking about fraudulent dealers as if they were part of the power mobility industry, CMS has cast a shadow of doubt on dedicated and hard working suppliers. It has unfairly caused the industry to lose valuable credibility with our regulators, Congress and even Medicare beneficiaries. The industry shares with CMS a strong desire to stop Medicare fraud, and we are encouraged that the agency has made fighting fraud a top priority. But every one would be better served if CMS didn’t refer to the scam artists as part of the legitimate power mobility industry.
It is equally frustrating that the industry receives the blunt of the criticism for the fraud when it has been lax supervision of the Medicare system that has resulted in the wasting of taxpayer dollars. It certainly seems hypocritical that the industry gets the blame when CMS allowed the Medicare scams to flourish. How do fraudulent dealers operate in the first place? They receive supplier numbers from CMS that allow them to bill the Medicare system for equipment that doesn’t get delivered to beneficiaries. Clearly, the key to stopping fraud is a system that better scrutinizes which companies receive supplier numbers to bill the Medicare system. The responsibility for doing so falls on CMS.
I’ll have Part 2 next time.