HMEs split 70-30 against K0011 coverage criteria

Sunday, February 29, 2004

YARMOUTH, Maine - If the critics of actions taken by CMS and the DMERCs to curb power wheelchair fraud and abuse have one sentiment in common, it’s this: Medicare might have nabbed the most egregious scam artists, but innocent providers and beneficiaries are paying the price.

Consider the case of Bill Murray, president of Adorno Mobility, which has locations in five Texas cities. Last year, 17% of Adorno’s medicare receievables were older than 90 days. Today, that percentage has ballooned to 56%, with 37% older than 150 days.

“This is a classic example of punishing the innocent,” Murray wrote in an email to HME News last month.

In last month’s HME NewsPoll, slightly more than two-thirds of 102 respondents thought Medicare had gone too far, too fast, holding up payments and enforcing a strict interpretation of medical coverage guidelines while a third of the respondents believed Medicare was on the right track.

“Whatever happened to the concept of being ‘innocent until proven guilty?’” wrote Jamie Blair, administrator in Genesis Respiratory Services located in New Boston, Ohio. “It is unfair for the industry as a whole to be judged by the small percentage of companies and individuals that file false claims on the K0011’s.”

At Kaiser Permanente, Peggy Scherrer suggested that the power wheelchair problem is much bigger than a few bad apples. She says 85% of the requests she receives as compliance officer are for patients who d not meet the Medicare criteria.

“It is way past time Medicare clamped down and I hope the investigation of fraudulent use of DME items continues,” she wrote.

Few of the revision’s critics believe the DMERCs have merely clarified the guidelines, but have indeed changed the policy.

“To implement this change without a comment period AND with retroactive ramifications for post-pay audits is unconscien-tious at best , and definitely bad policy,” wrote Tim Pontius, president of Young Medical Equipment in Toledo,Ohio.

“Come on, no notice, no public forum, retro-active for current claims, no clear interpretation, how can you expect the best outcome for the consumer in this closed loop, are we not all in this together and need to network for the best and correct outcome?” he writes.

Plenty are fired up that they’re being asked to both submit to changes and pay the price while none of the overseers seem to be bearing any responsibility K0011 fraud and abuse.

“The government needs to justify to itself that it is in and of itself being of value to the general public,” wrote Jim Toney, an RTS and ATS at Home Care Supply in Region C. “It needs to show the population that it is being entrusted to guard the general welfare and maintain the trust of its citizens.”

“CMS needs to understand and take the fall for paying all those K0011 Houston claims,” echoed Debby Glenewinkel, manager of the Mobility Store in Seguin, Texas.

In Tyler, Texas, Kevin Hill sees mobility dealers who who he says are providing power in contradiction to the guidelines.

“It is high time that the purse strings on this abusive situation are drawn close,” he wrote.