DMERCs looking behind CMN, attorney warns HMEs

Monday, December 31, 2001

WASHINTON - The DMERCs have recently been taking closer and harder looks behind CMNs because they feel suppliers have compromised the certificates and are intentionally trying to affect the demand for equipment like power wheelchairs, a healthcare attorney is warning.

Tom Antone, who spoke of the trend during a seminar at Medtrade, said not only are the DMERCs requesting additional information, such as physician chart notes, from suppliers, they're also asking for that information directly from physicians.

"It used to be that if a supplier had a CMN or prescription, the government would rarely look behind those," said Antone, of the law firm Mintz, Levin. "But they're increasingly looking behind those now, in suspect products and suppliers."

Suppliers of electrotherapy equipment and diabetic footwear have already been hit by the new auditing tactic (See HME News, September 2001 and November 2001).

Antone said what's taking place is "Act II" of an investigation the DMERCs began several years ago on three-wheeled scooters. The difference: Then, they saw a spike and gave suppliers warning; now, they're seeing a spike, investigating immediately and handing down indictments.

There are two scenarios where suppliers might run into problems, Antone said. The first is with TV advertising, where beneficiaries typically call a 1-800 number for equipment, usually wheelchairs, and never receive a face-to-face evaluation from a physician before receiving the wheelchair.

The second involves nurses or therapists, who see themselves as patient advocates, asking the supplier for more than what's needed, at least in the eyes of the DMERCs, and the supplier not correcting them.

In both cases, Antone said suppliers must educate physicians, nurses, etc. on DMERC policies and ensure that medical necessity is well documented.

"Remember the suppliers the ones on the hook because it's going to be a significant hit," he said. "At the bare minimum they'll ask for refunds, but more likely it'll be corrective action." HME