CMS forum addresses 'free' gifts to beneficiaries, accreditation, bidding

Wednesday, September 9, 2009

BALTIMORE – HME providers must take care not to run afoul of the law when it comes to giving free supplies and equipment to beneficiaries, CMS official Sandra Bastinelli told listeners during yesterday’s Open Door Forum.

“The provision of free supplies to beneficiary who purchased other covered items or drugs implicates the civil monetary penalty statute that prohibits inducements to beneficiaries as well as the anti kick-back statute,” Bastinelli said.

Likewise, the anti-kickback statute could be triggered if a provider receives supplies for free from a manufacturer. In both cases, the specific circumstance of the freebie determines if a statute is being violated, she said.

Bastinelli also addressed several issues related to accreditation:

   — Some pharmacies are still uncertain if they must become accredited, to which Bastinelli explained: If a pharmacy is billing a DME MAC for a covered product, the pharmacy must be accredited by Oct. 1 to continue doing so. A pharmacy does not need to become accredited if it is billing a DME MAC for drugs and biologicals.

   — If a provider has obtained a surety bond and is ready for an accreditation survey but is unlike to receive it by the Oct. 1 deadline, what are his options? There are two. The company can amend its CMS 855S to furnish only drugs and biologicals if it is a pharmacy. Or the provider can voluntarily withdraw from the Medicare program.

CMS’s Joel Kaiser also reminded providers—those planning to participate in competitive bidding’s round 1 rebid—to designate an authorized official (AO), and register that person with the NSC by Sept. 14. The AO will serve as a provider’s bidding point person. The AO will be assisted by a backup authorized official (BAO) and end user (EU). BAOs should register by Oct. 4; EUs by Nov. 4.

When registering, providers must make sure the 855S enrollment forms on file with the NSC are up to date, including the legal names, dates of birth and Social Security numbers of their AOs and BAOs.