Fraud and abuse: Industry prepares to fight 'albatross'

Sunday, September 28, 2008

WASHINGTON - AAHomecare and other industry stakeholders are laying the groundwork to launch an organized and aggressive campaign to fight HME fraud and abuse in 2009.

AAHomecare has been interviewing public relations firms and putting together legislative proposals.

"The fraud and abuse issue is like an albatross around the HME industry's neck," said Walt Gorski, AAHomecare's vice president of government affairs. "Any positive message that comes from a patient receiving home care is quickly erased by the next fraud and abuse story. We need a concerted effort to tackle this issue."

Most recently, a Senate subcommittee last week released a report that alleges Medicare paid $4.5 billion for medical equipment claims with invalid or blank codes between 1995 and 2005. Mainstream newspapers like USA Today ran with the story, reveling in details like this one: Some claims featured smiley faces instead of proper codes.

AAHomecare plans to have a PR firm hired by the end of 2008. The firm will help publicize several principles about HME (that it provides value by keeping patients out of institutions) and dispel certain myths (that it's a big source of healthcare fraud) to policymakers in Congress and at CMS, as well as Mr. and Mrs. Smith.

AAHomecare will pay the firm with money raised at its annual "Stand up for Homecare" fundraiser (it still has about $50,000 in the bank from the first two events) and other fundraisers.

"This will be a significant step forward to get us out in front of this issue," said Michael Reinemer, AAHomecare's vice president of communications and policy.

The legislative proposals, which AAHomecare plans to shop around in the next Congress, outline steps to curb fraud and abuse. Two of those steps: creating a real-time system for auditing claims and ramping up supplier enrollment requirements.

"We need to focus on standards for new providers," said Seth Johnson, vice president of government affairs for Pride Mobility Products. "There needs to be site visits, two, three, four times a year. There needs to be a probationary status, until a new provider meets certain criteria. I think most would support these types of measures."

AAHomecare has received support for the campaign from "big players in the industry," Reinemer said.

Going into 2009, Invacare views fraud and abuse as the No. 1 priority for the industry.

"If we are to gain any positive traction in the coming years with Congress and CMS, we must reverse our image," said Cara Bachenheimer, Invacare's senior vice president of government affairs. "We must come forth with concrete proposals to address problems and work with the government as a partner, not as an adversary."