CMS takes new approach to fraud

Thursday, June 9, 2011

INDIANAPOLIS – HME industry stakeholders are calling a new fraud and abuse pilot program that’s taking place here “proactive” and “cutting edge.”

The pilot program, spearheaded by National Government Services (NGS), the Jurisdiction B DME MAC, entails providing volunteer physicians and HME providers with magnetic swipe cards. When a physician orders or refers DMEPOS, he swipes the card and enters the last four digits of the Medicare beneficairy’s health insurance claim number into his swipe terminal. When an HME provider fills the order, he does the same thing. NGS will match the information coming from the card swipe to the information in the claim.

“By verifying that a legitimate physician wrote an order for DME and that it was dispensed by a legitimate supplier, certain types of fraud and abuse can be eliminated from the program,” the NGS writes in an FAQ on the pilot program.

NGS is asking physicians and HME providers to use the cards for one year.

Stakeholders say they’re watching the pilot program closely. Their initial reaction: In a world where HME providers are dogged like never before by post-pay audits, they give NGS credit for its “proactive” approach to reducing fraud and abuse.

“We favor any measure that uses real-time verification rather than pay and chase,” said Michael Reinemer, vice president of communications and policy for AAHomecare.

If it goes well, stakeholders also see many ways the pilot program could be expanded. What if beneficiaries were given cards and they used them at their physician’s office and at their HME provider’s location, and HME providers were paid based on the card swipe and claims submissions? What if using the cards as fraud prevention tools meant stopping the audits as fraud prevention tools?

“It’s cutting-edge stuff,” said Wayne Stanfield, executive director of NAIMES.

Apria Healthcare has volunteered to participate in the pilot program. Its branch in Indianapolis is one its largest and longest established. Indianapolis-based Home Health Depot hadn’t volunteered yet, but CEO David Hartley called the program “really interesting.”

At the end of the day, however, stakeholders caution CMS and its contractors about piling another fraud program on top of so many others.

“It’s also important to check on all these other efforts already in place,” Reinemer said. “How effective have accreditation and surety bonds been? We don’t need more needless burdens or costs for legitimate providers.”

To find out more about the pilot program, click here.