Opinion: Medicares Witch Hunt- Again

Opinion: Medicares Witch Hunt- Again

Saunders, Jan CPO

Please read the CMS/Medicare bulletin released July 2, 2007. This is the
second time the CMS is addressing this as a problem with our industry, remember,
they consider us to be providers of durable medical equipment (saleman).
After the last investigation, it was exposed, that Medicare/Blue Cross Blue
Shield had made payments to companies in South Florida, for millions, who were
unlicensed in the State of Florida. To be provider for Medicare the DMERCs
are required to follow all State, local and federal law's. Florida statutes
require state licensure, which means had Medicare/Blue Cross Blue Shield done
their job properly. Payments never should have been made, because Medicare
was put on the hot seat and needed a quick scapegoat, we are that scapegoat.
You need to immediately contact any elected officials in your area to let them
know this is a witch hunt and educate them on the importance of separating
DME from Prosthetics & Orthotics.
This is why it is so critically important that we must be separated from DME
 
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.



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