ANNOUNCE: Academy Response to Fraud & Abuse Published in LA Times
Manisha Bhaskar
Description
Collection
Title:
ANNOUNCE: Academy Response to Fraud & Abuse Published in LA Times
Creator:
Manisha Bhaskar
Date:
7/13/2007
Text:
On Monday, July 2, 2007 the Los Angeles Times printed the article below
on Medicare's intent to clamp down on fraud and abuse. Since orthotics
and prosthetics were mentioned in the article the Academy felt it
important to respond.
Academy President Wendy Beattie, CPO, FAAOP, wrote a letter to the
editor stating the Academy's position on this issue and stressing that
one of the ways that we could cut down on fraud and abuse was to support
both licensure and certification based on high level education
requirements as well as strict accreditation requirements for
businesses. These requirements would be based on businesses using
appropriately qualified professionals for the work they are doing.
On July 9, 2007 the LA Times did print the letter below from our Academy
President. Though they took the liberty of editing the original letter
the Academy feels that it represents our strong views on the issue of
fraud and abuse and the need to protect the public.
Medicare to clamp down on fraudulent suppliers
Claudia Lauer, Jack Leonard, Los Angeles Times
Monday, July 2, 2007
(07-02) 04:00 PDT Washington -- Fraudulent Medicare billings submitted
by medical equipment suppliers in the Los Angeles area and south Florida
are the target of a pilot program to be announced today by the
Department of Health and Human Services.
The two-year program, which was developed by the Centers for Medicare
and Medicaid Services, will concentrate on fake bills or overcharges
sent by suppliers of prosthetic limbs, orthotics, diabetic supplies and
durable medical equipment, which includes such items as wheelchairs and
nebulizers.
The nationwide figure for such fraud could reach several billion dollars
a year, according to Medicare. If the pilot program is successful in the
two regions, it probably will be rolled out nationwide.
In the Los Angeles area, there are over 4,800 durable medical equipment
suppliers. Because there are so many suppliers and such a high number of
beneficiaries, it creates an opportunity for this kind of fraud, said
Kimberly Brandt, Medicare's director of program integrity.
The U.S. attorney in Los Angeles has a special unit of four prosecutors
devoted to filing criminal cases, and the office uses civil lawsuits to
seek reimbursements for improper billing.
A U.S. attorney's spokesman said most cases involve defendants accused
of overcharging the federal health insurance program or billing for
unnecessary or undelivered services.
The program set to be unveiled by the Centers for Medicare and Medicaid
Services will focus on companies that supply medical equipment.
Last year, the agency responsible for vetting companies that bill
Medicare for supplies started visiting hundreds of sites in Los Angeles.
The effort resulted in 95 suppliers losing their billing privileges.
On Friday, Mike Leavitt, secretary of health and human services,
described how, in May, he accompanied a fraud investigation task force
to southern Florida, where he saw some of the scams firsthand. In a
two-story office building with nearly 60 providers of durable medical
equipment, Leavitt said, it was hard to find a legitimate company.
It was a long web of hallways with doorways on each side, and each
would have a small marquee with a list of business hours and a contact
number, he said. But when I'd knock on the door, no one was there.
There were hundreds of thousands of dollars being billed by these sham
companies, he said.
Leavitt said he asked the building manager about renting space for a
diabetes supply company. He said the manager told him that he would need
only a minimal amount of space and gave him the name of a consultant who
could help him set up a fake company.
In my mind, it was clear that there was something really wrong here,
he said.
Of 1,500 dealers the task force visited that week, Leavitt said, about
300 were being terminated from the Medicare program because they were
not active businesses but shell companies charging for fictional
services. Similar investigations in the Los Angeles area resulted in the
revocation of Medicare privileges for 108 companies between January and
April.
Most cases investigated by the task force came from poring over billing
information and interviewing physicians or Medicare patients who found
that something didn't seem right on a bill.
The program will try to weed out dealers that pass through a series of
requirements to get a Medicare billing number, which is the key to
sending Medicare claims, and close up shop after submitting several
claims.
Others offer money to poor Medicare recipients for their program numbers
and bill the government for services the patients don't need or were
never prescribed. Still others do provide the prescribed equipment but
bill Medicare for upgrades or more expensive equipment the patient never
receives.
The government also will strengthen the requirements for new dealers to
obtain Medicare billing numbers, including stringent background checks
for company owners and managers. Companies already enrolled in the
program will be required to reapply for billing privileges annually
instead of every three to five years. And equipment providers can expect
to see a lot more of the Medicare staff, Brandt said.
A lot of the ways the program is targeting fraud is by being very
aggressive about having more on-site inspections, she said.
Los Angeles Times- Letter to the Editor- July 9, 2007
Response to article on Fraud and Abuse in the LA Times
Certification will prevent abuses
July 9, 2007
Re Federal effort to target medical fraud, July 2
It is unacceptable for illegitimate companies to become suppliers
allowed to bill for durable medical equipment and prosthetics and
orthotics services. This costs us all and especially hurts those who
rely on these devices and services to live full and productive lives.
The American Academy of Orthotists and Prosthetists supports licensure
and education-based certification for individuals and strict
accreditation for businesses.
It is crucial that the practitioner providing the service and the
business billing for it follow high standards to prevent the abuse
referred to in this article.
WENDY BEATTIE
President
American Academy of
Orthotists and Prosthetists
Alexandria, Va.
Manisha S. Bhaskar
American Academy of Orthotists and Prosthetists
Director of Marketing & Publications
526 King Street, Suite 201
Alexandria, VA 22314
(703) 836-0788, ext. 210
FAX (703) 836-0737
www.oandp.org < <URL Redacted>>
********************
To unsubscribe, send a message to: <Email Address Redacted> with
the words UNSUB OANDP-L in the body of the
message.
If you have a problem unsubscribing,or have other
questions, send e-mail to the moderator
Paul E. Prusakowski,CPO at <Email Address Redacted>
OANDP-L is a forum for the discussion of topics
related to Orthotics and Prosthetics.
Public commercial postings are forbidden. Responses to inquiries
should not be sent to the entire oandp-l list. Professional credentials
or affiliations should be used in all communications.
on Medicare's intent to clamp down on fraud and abuse. Since orthotics
and prosthetics were mentioned in the article the Academy felt it
important to respond.
Academy President Wendy Beattie, CPO, FAAOP, wrote a letter to the
editor stating the Academy's position on this issue and stressing that
one of the ways that we could cut down on fraud and abuse was to support
both licensure and certification based on high level education
requirements as well as strict accreditation requirements for
businesses. These requirements would be based on businesses using
appropriately qualified professionals for the work they are doing.
On July 9, 2007 the LA Times did print the letter below from our Academy
President. Though they took the liberty of editing the original letter
the Academy feels that it represents our strong views on the issue of
fraud and abuse and the need to protect the public.
Medicare to clamp down on fraudulent suppliers
Claudia Lauer, Jack Leonard, Los Angeles Times
Monday, July 2, 2007
(07-02) 04:00 PDT Washington -- Fraudulent Medicare billings submitted
by medical equipment suppliers in the Los Angeles area and south Florida
are the target of a pilot program to be announced today by the
Department of Health and Human Services.
The two-year program, which was developed by the Centers for Medicare
and Medicaid Services, will concentrate on fake bills or overcharges
sent by suppliers of prosthetic limbs, orthotics, diabetic supplies and
durable medical equipment, which includes such items as wheelchairs and
nebulizers.
The nationwide figure for such fraud could reach several billion dollars
a year, according to Medicare. If the pilot program is successful in the
two regions, it probably will be rolled out nationwide.
In the Los Angeles area, there are over 4,800 durable medical equipment
suppliers. Because there are so many suppliers and such a high number of
beneficiaries, it creates an opportunity for this kind of fraud, said
Kimberly Brandt, Medicare's director of program integrity.
The U.S. attorney in Los Angeles has a special unit of four prosecutors
devoted to filing criminal cases, and the office uses civil lawsuits to
seek reimbursements for improper billing.
A U.S. attorney's spokesman said most cases involve defendants accused
of overcharging the federal health insurance program or billing for
unnecessary or undelivered services.
The program set to be unveiled by the Centers for Medicare and Medicaid
Services will focus on companies that supply medical equipment.
Last year, the agency responsible for vetting companies that bill
Medicare for supplies started visiting hundreds of sites in Los Angeles.
The effort resulted in 95 suppliers losing their billing privileges.
On Friday, Mike Leavitt, secretary of health and human services,
described how, in May, he accompanied a fraud investigation task force
to southern Florida, where he saw some of the scams firsthand. In a
two-story office building with nearly 60 providers of durable medical
equipment, Leavitt said, it was hard to find a legitimate company.
It was a long web of hallways with doorways on each side, and each
would have a small marquee with a list of business hours and a contact
number, he said. But when I'd knock on the door, no one was there.
There were hundreds of thousands of dollars being billed by these sham
companies, he said.
Leavitt said he asked the building manager about renting space for a
diabetes supply company. He said the manager told him that he would need
only a minimal amount of space and gave him the name of a consultant who
could help him set up a fake company.
In my mind, it was clear that there was something really wrong here,
he said.
Of 1,500 dealers the task force visited that week, Leavitt said, about
300 were being terminated from the Medicare program because they were
not active businesses but shell companies charging for fictional
services. Similar investigations in the Los Angeles area resulted in the
revocation of Medicare privileges for 108 companies between January and
April.
Most cases investigated by the task force came from poring over billing
information and interviewing physicians or Medicare patients who found
that something didn't seem right on a bill.
The program will try to weed out dealers that pass through a series of
requirements to get a Medicare billing number, which is the key to
sending Medicare claims, and close up shop after submitting several
claims.
Others offer money to poor Medicare recipients for their program numbers
and bill the government for services the patients don't need or were
never prescribed. Still others do provide the prescribed equipment but
bill Medicare for upgrades or more expensive equipment the patient never
receives.
The government also will strengthen the requirements for new dealers to
obtain Medicare billing numbers, including stringent background checks
for company owners and managers. Companies already enrolled in the
program will be required to reapply for billing privileges annually
instead of every three to five years. And equipment providers can expect
to see a lot more of the Medicare staff, Brandt said.
A lot of the ways the program is targeting fraud is by being very
aggressive about having more on-site inspections, she said.
Los Angeles Times- Letter to the Editor- July 9, 2007
Response to article on Fraud and Abuse in the LA Times
Certification will prevent abuses
July 9, 2007
Re Federal effort to target medical fraud, July 2
It is unacceptable for illegitimate companies to become suppliers
allowed to bill for durable medical equipment and prosthetics and
orthotics services. This costs us all and especially hurts those who
rely on these devices and services to live full and productive lives.
The American Academy of Orthotists and Prosthetists supports licensure
and education-based certification for individuals and strict
accreditation for businesses.
It is crucial that the practitioner providing the service and the
business billing for it follow high standards to prevent the abuse
referred to in this article.
WENDY BEATTIE
President
American Academy of
Orthotists and Prosthetists
Alexandria, Va.
Manisha S. Bhaskar
American Academy of Orthotists and Prosthetists
Director of Marketing & Publications
526 King Street, Suite 201
Alexandria, VA 22314
(703) 836-0788, ext. 210
FAX (703) 836-0737
www.oandp.org < <URL Redacted>>
********************
To unsubscribe, send a message to: <Email Address Redacted> with
the words UNSUB OANDP-L in the body of the
message.
If you have a problem unsubscribing,or have other
questions, send e-mail to the moderator
Paul E. Prusakowski,CPO at <Email Address Redacted>
OANDP-L is a forum for the discussion of topics
related to Orthotics and Prosthetics.
Public commercial postings are forbidden. Responses to inquiries
should not be sent to the entire oandp-l list. Professional credentials
or affiliations should be used in all communications.
Citation
Manisha Bhaskar, “ANNOUNCE: Academy Response to Fraud & Abuse Published in LA Times,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 2, 2024, https://library.drfop.org/items/show/228370.
