Fraud and abuse 'pinning us down'

Sunday, June 3, 2007

WASHINGTON - The big Medicare fraud bust in Miami this spring couldn't have come at a worse time.

As the industry fights to scale back competitive bidding, reverse the 36-month cap on oxygen reimbursement and tackle other regulatory and legislative initiatives, "the fraud issue is pinning us down," said one well-placed industry watcher.

"It's the No. 1 issue that keeps us from being able to--so far--prevail on the advocacy part of our job," added Jim Walsh, general counsel for The VGM Group. "We cannot effectively lobby for our industry when everybody in the Capitol is focused on fraud and abuse."

In a highly publicized enforcement effort, federal investigators in May arrested 38 people in south Florida for allegedly providing false prescriptions for compounded inhalation medications. Overall, since announcing a federal-state healthcare fraud initiative in 2005, the U.S. Attorney's Office has charged nearly 200 defendants with schemes that defrauded Medicare out of $150 million.

News like this makes it more difficult for the industry to line up legislative support for industry bills. Additionally, with lawmakers looking for additional Medicare savings in 2008, "it makes DME an easier target," said Cara Bachenheimer, Invacare's vice president of government relations.

"It makes it tougher to make our argument to leave us alone," she said.

That means a chance exists that legislators may seek Medicare savings by proposing to further reduce the cap on oxygen reimbursement and/or eliminate the first-month purchase option for power wheelchairs, say industry watchers.

After five months on the job, Walt Gorski, AAHomecare's vice president of government affairs, said he still can't figure out why bad PR seems to stick more to HME than to other industries.

"It's our goal to confront this issue head on and point out that virtually all HME providers are following the rules and regulations," he said. "We need to be more proactive in highlighting our positions aimed at curbing fraud and abuse."

For example, AAHomecare strongly supports accreditation, and is doing what it can to make sure CMS enforces current standards and requirements designed to keep crooks from billing the Medicare system, he said.

Over the Memorial Day recess, May 26 through June 3, when members of Congress will be working in their home states or districts, providers can do the same. In addition to sounding the alarm over fraud and abuse, providers can schedule meetings with their senator or representative or host a site visit. Having lawmakers home for the holiday presents a good opportunity to lobby for industry legislation, say industry watchers.