Industry attorney talks audits with CMS official

Thursday, October 20, 2011

WASHINGTON – CMS officials know that audits are putting HME providers, good and bad, through the ringer and the agency is working on improving the process. That’s the message Edward Vishnevetsky, an industry attorney, took away when he participated in a panel discussion on audits with Ted Doolittle, deputy director of policy for the Center for Program Integrity at CMS, during the American Bar Association’s Washington Healthcare Summit last week. Here’s what Vishnevetsky, an associate at Munsch Hardt Kopf & Harr, told HME News about this hour-and-a-half discussion.

HME News: How is CMS trying to improve the audit process?

Edward Vishnevetsky: They’re working on some new, proactive data analysis. They understand the plight of the DME providers; they’re aware that a lot of companies are shutting down because of the timeframe for these audits. He said, “We’re trying to make it harder for the bad guys and shorter for the good guys, but we just haven’t been able to come up with the algorithms yet to discern that.” They’re trying to put algorithms into computers that, hopefully, discern between different types of providers.

HME: It sounds like they want to be able to use a scalpel instead of an ax.

Vishnevetsky: That’s pretty much it. The purpose of the audits is good, but this is what’s happened: To make an omelet, you have to crush a few eggs, but here they’ve crushed a lot. They’re trying to get better.

HME: How did you communicate the DME industry’s frustration with the audit process?

Vishnevetsky: I said the DME industry agrees that fraud needs to be curbed, but this process has had some growing pains, especially related to the timeframe that the ZPICs have to respond. That’s really been the biggest problem. Everything just gets sent up to the next level, and providers get caught up in that. That leads to loss in revenue, an increase in bankruptcy filings, loss of referrals and, ultimately, just a decrease in the number of companies that are out there.

HME: Did you learn anything new about the process during the discussion?

Vishnevetsky: We thought the ZPICs got bonuses if they find more instances of fraud and they don’t. The RACs do, but not the ZPICs.

HME: What do you think Doolittle took away from the discussion?

Vishnevetsky: He took a lot of notes on what we were saying. He seems impassioned about his job, so I’m hoping that he’ll effectuate some change.