Audits 'picking off' providers

Sunday, September 30, 2007

SACRAMENTO, Calif. - Rehab providers in California plan to band together to fight Medicaid's charges that they have violated an obscure upper billing limit rule.
In early September, provider Tom Lambert had collected the names of about 20 providers audited for billing more than cost-plus 100% for wheelchairs, namely K0011s. They argue that the state failed to educate them on the rule, which it implemented four years ago to cut down on fraud and abuse.
"They had to be aware there was a major problem," said Lambert, president of Maximum Comfort in Redding, Calif. "Yet they didn't correct us. Now they're just picking us off one at a time."
Unaware of the rule, providers say they continued to bill Medicaid using the established allowable for K0011s, about $5,000. But because K0011s can cost as little as $1,500, providers should have billed less than that in some cases, Medi-Cal claims. Now it's after the difference--up to $500,000 in one case, according to sources.
Providers like Lambert are fighting the audits through the proper channels, but they're also asking the state to suspend its activities pending an effective education campaign.
Due to the audits, providers like Doe Cayting spend more time processing orders.
"Most computer systems are set up so you plug in the allowable and go," said Cayting, director of Wheelchairs of Berkeley in San Francisco. "Now we have to override the system and look at everything."
Provider Rick Frelke wishes the state would just allow providers "a certain percentage across the board."
"That would prevent this system of certain chairs subsidizing other chairs," said Frelke, a sales manager for Mobility Solutions in San Diego. "It's unfair."