Fraud demo raises questions, concerns

Sunday, November 25, 2007

YARMOUTH, Maine - A glitch with provider enrollment form 855S was fixed last week, but providers in south Florida and the Los Angeles area who are reapplying for their Medicare billing numbers should verify that all information is correct before sending it in, say industry leaders.

"All you need is one mistake to lose your supplier number," said Joan Cross, chairperson of the National Suppliers Clearinghouse Advisory Committee.

In July, CMS announced a two-year demonstration project to crack down on fraud, requiring about 5,000 providers in the Los Angeles area and about 2,700 providers in south Florida to resubmit form 855S within 30 days of notification.

Providers have begun receiving notification letters--and encountering issues.

Raul Lopez, operations manager for Miami Lakes, Fla.-based Bayshore Dura Medical, had problems with the form auto-filling itself. After checking off the box denoting the company as a DME supplier, the form then filled in places indicating Bayshore offers pharmacy, prosthetic and parenteral services and products--which it doesn't.

"The system would automatically change our answers and spit it out, basically, self-filling with inaccurate information," said Lopez. "Luckily, we caught it. My fear is somehow the file got corrupted."

CMS also planned to conduct background checks and unannounced site visits as part of the re-enrollment process.

Jim Leedom, owner of Home Health Depot in Lomita, Calif., got hit with an onsite inspection while attending Medtrade in October. Last week, he was still waiting to hear if he would lose his number.

"My staff missed one piece of paper the inspector wanted," said Leedom. "I didn't get back from Medtrade until Friday and I went in on the following Monday, a holiday, and faxed it to them. Tuesday, I got a fax back saying I missed the two-day deadline."

AAHomecare was seeking clarification about whether providers have to also become accredited within 120 days of receiving the notification letter, said Walt Gorski, vice president of government relations.