Fraud and abuse called 'easy to get away with'

Sunday, September 30, 2007

HME providers don't deny that fraud and abuse continues to plague their industry, but, they say, they're not to blame. That honor goes to none other than CMS. If not for decades of lax oversight and the emergence of loopholes you could drive a power wheelchair through, the industry might not be the target of persistent and ongoing investigations.
In the September HME NewsPoll, providers admitted to the prevalence of fraud in their business, but they claim that the same sort of thing goes on throughout the continuum of care. HME providers get a bad rap because they lack the resources necessary to fight back.
"We can't compete with the hospitals, nursing homes, and pharmaceutical companies," said Walter McGowan of Dermer Pharmacy. "And unfortunately in this country, money is the equivalent to a bull horn in regards to getting anyone in the government to listen to us."
Says another supplier: "CMS would not dare consider penalizing the physicians as a whole because a minority group of physicians commit fraud. Why has it taken over 15 years to finally realize that something needs to be done to effectively curb fraud and abuse in HME?"
Suppliers also find fault with themselves for not acting on what they see and hear. The industry, they say, does a lousy job of policing itself.
"Due to apathy or simply turning a blind eye to known or suspected fraud in any one demographic area, most providers take a 'it ain't my problem"' attitude," said Stewart Pace of Med-South in Birmingham, Ala.
But even when suppliers do pick up the phone, they say, their complaints gain little traction within the government.
"I reported fraud of a few dealers for years with documentation and no action was forthcoming," said Dave Jacob of Certified Medical Systems.
Suppliers bemoan the fact that CMS seems to make rules but not enforce them, at least not until its too late.
"When you only have two investigators for five states, what do you expect," said one supplier. " Fraud is too easy to get away with in this industry."
Without a professional degree to act as a hedge against unethical behavior, more than a few suppliers believe that accreditation would have (and now may) snuff out the bad guys.
Again, CMS is to blame for not calling for this a long time ago, they say. For years, the agency handed out supplier numbers to just about anyone who applied.
"I would like to know how much fraud would be avoided if Medicare actually did their job and performed on-site visits before administering a provider number," a provider wrote. "Let's face it, it is better to stop something before it happens than trying to catch someone after they have done something wrong."