AAHomecare stresses zero tolerance for fraud, abuse

Sunday, March 11, 2007

ARLINGTON, Va. - AAHomecare stressed its zero tolerance for Medicare fraud and abuse in a statement last week during federal hearings on Medicare integrity. Home medical equipment was not a major focus of the hearings, which were broad in scope. The HME-related cases discussed were fly-by-night operations in south Florida.

"We were holding our breath, but they looked at hospitals, Part D drugs, everything," said Michael Reinemer, AAHomecare's vice president of communications and policy. "We were not singled out, and we came out with a very strong statement."

The U.S. House of Representatives conducted the March 8 hearings. AAHomecare submitted the following statement:

On behalf of the American Association for Homecare's more than 4,000 member locations serving Medicare beneficiaries in every state in the nation, we sincerely appreciate the opportunity to submit this statement for the joint hearing held by the Committee on Ways and Means Subcommittee on Health and Subcommittee on Oversight regarding program integrity issues in the Medicare program.

AAHomecare represents all lines of service and therapy in the homecare community, including home medical equipment providers, respiratory therapy, infusion therapy, telemedicine, and rehab and assistive technology.

The association remains committed to rooting out fraud and abuse and is eager to continue its work with CMS to improve program integrity for Medicare. The association and its members support prompt, reliable and effective homecare products and services appropriate to each individual's needs, health and safety, as well as compliance with applicable federal, state, and local laws and regulations.

As we have previously testified before Congress, AAHomecare refuses to tolerate the stealing of taxpayers' dollars set aside for the care of Medicare beneficiaries. We advocate zero tolerance for Medicare fraud and abuse of any kind. AAHomecare will continue to assist CMS and federal law enforcement agencies in efforts to ensure the integrity of the Medicare program.

We caution against any overgeneralizations about the homecare sector. The vast majority of home medical equipment providers and manufacturers are operated by hard-working Americans, in many cases family operations involving multiple generations, who are dedicated to providing the best possible therapies and medical equipment to treat and improve medical conditions for patients at fair prices. The patients our members serve suffer from a variety of conditions ranging from multiple sclerosis and congestive heart disease to COPD. Law-abiding providers and manufacturers that we represent understand the importance of forming transparent, long-term relationships with the Medicare program and they make every effort to comply with Medicare's rules and regulations. Those providers who are not focused on the long-term appropriate needs of their patient community harm the program, and more importantly, the patients.

We offer several suggestions for addressing fraud and abuse.

First, the guiding principle should be to provide Medicare beneficiaries with medical equipment technology and therapies that are medically necessary and appropriate to give the patient a fuller, more satisfying and healthier life.

Second, Medicare coverage, coding, reimbursement and documentation policies as well as standards for quality, should be clear and unambiguous. In recent years, for instance, AAHomecare has worked with CMS and its contractors to revise coding for power wheelchair products to improve Medicare coding and coverage practices.

The association also has embraced the federal quality standards and accreditation requirements for home medical equipment required by the Medicare Modernization Act of 2003 (MMA) and has worked closely with CMS to develop sound quality standards. In fact, last year we recommended that CMS adopt standards that were far more stringent than what the agency adopted in its final standards issued in November 2006. Many of the requirements from the MMA are only now nearing implementation.

Third, the Medicare program has numerous anti-fraud and abuse safeguards in place that must be more effectively enforced. Currently, the Medicare program requires that suppliers adhere to 21 specific supplier standards (42 CFR 424.57) in order to obtain and maintain billing privileges.

We believe that proper enforcement of the current 21 standards along with new quality standards and accreditation will go a long way toward cracking down on criminal activity. For example, Medicare and its contractors currently have the ability to conduct on-site inspections to ascertain the provider's compliance with the supplier standards (42 CFR 424.57(8)). The National Supplier Clearinghouse (NSC) is also required to conduct on-site inspections when it issues a new supplier number and every three years upon renewal. Shell companies that are purposefully out to defraud the Medicare program should not be able to pass these unannounced site inspections.

We would appreciate the opportunity to share our expertise with the distinguished members of this committee and officials with CMS and its contractors to root out bad actors who sully the reputation of the vast majority of honest DMEPOS suppliers who provide cost-effective care to our nation's Medicare beneficiaries.

The association and the homecare community abhor cases of knowing submission of false claims and violations of anti-fraud and abuse statutes. We strongly advocate for ethical and honest participation in Medicare and also for clear, up-to-date, and fair regulation that targets fraud and abuse but does not burden those providers who make every effort to follow the rules. We will continue to serve as a knowledgeable resource for HHS and all others in this effort, including this Committee.

Home medical equipment is a critically important benefit that serves millions of beneficiaries. Secretary Michael Leavitt has called for greater use of home- and community-based care in Medicaid because "it's not only where people want to be served, but it's radically more efficient."

AAHomecare appreciates the opportunity to present these comments for your consideration. We look forward to working with the Committee on rational and effective measures to ferret out fraud and abuse and protect vulnerable Medicare beneficiaries.