‘AOs are vigilant in looking for fraud’

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Thursday, July 25, 2019

OWINGS MILLS, Md. – How much of a role do accrediting organizations play in helping to prevent and eliminate fraud, waste and abuse?

“Throughout the accreditation process, AOs are vigilant in looking for fraud, waste and abuse,” said Matthew Gruskin, the credentialing director for the Board of Certification/Accreditation (BOC). “CMS requires AOs to conduct site surveys to check for compliance with CMS Quality and Supplier Standards. Many of these standards are designed to help prevent fraud.”

Here’s what else Gruskin had to say:

HME News: Preventing and eliminating fraud was one of the reasons CMS began requiring accreditation to begin with, right?

Matthew Gruskin: CMS began requiring accreditation to ensure all suppliers comply with CMS Quality Standards to receive Medicare Part B payments and to retain a supplier billing number. Requiring compliance with these standards also helps prevent fraud.

HME: What parts of the accreditation process help to keep fraud at bay?

Gruskin: The entire accreditation process is designed to ensure compliance with CMS standards. If fraud, waste and abuse are identified during the accreditation process, the AO immediately reports it to the National Supplier Clearinghouse and possibly other entities, as well. The NSC follows up on concerns involving suspected fraud.

HME: One would think that the required on-site surveys would be one of the more effective ways to determine fraud.

Gruskin: Every supplier has an unscheduled initial survey. The AO also conducts an unscheduled follow-up survey if a concern arises. Site surveyors thoroughly assess compliance with required standards and regulations.

HME: What happens when an AO suspects fraud?

Gruskin: Every AO reports suspicious activity as part of their relationship with NSC and CMS. For example, if a business operates for months with no patient charts, if all patient charts come from the same physician, or if all charts reflect orders for the same products, an AO would report these findings to the NSC.