'It's time to take the gloves off' about fraud

Sunday, October 21, 2007

MIAMI - Wheelchairs and walkers are not the new drugs of choice for dealers looking for other ways to turn an illegal buck, say providers and industry leaders up in arms over a recent story that aired on National Public Radio (NPR).

"Enough is enough," said John Gallagher, VGM's vice president of government relations. "It's time to take the gloves off."

The Oct. 11 story about the $35-billion-a-year Medicare fraud industry, reported by Greg Allen, made it sound as though HME was the sole perpetrator of abuse when it's only a small fraction of the problem and Medicare's overall $368 billion budget, said Raul Lopez.

"Those numbers are very skewed," said Lopez, director of operations for Bayshore Dura Medical in Miami Lakes, Fla., and president of the Florida Association of Medical Equipment Services (FAMES).

The story placed particular emphasis on South Florida, which has made the news frequently, thanks in part to the high profile Medicare Strike Force. The program, launched in March, has resulted in 120 people charged with an estimated $300 million to $400 million in fraudulent claims.

Placing the blame for all Medicare fraud on HME's shoulders is unfair, said provider Rob Brant.

"It's amazing they only pick on us when they could pick on doctors and hospitals the same way," said Brant, general manager of City Medical Services in Miami Beach, Fla.

The real story, said industry leaders: Why has CMS failed so miserably at preventing fraud?

"This has been a problem for 30 years," said Mike Reinemer, vice president of communications and policy for AAHomecare. "Why is this continuing to be such a problem of pay-and-chase after the bank heist, rather than a stronger lock on the bank door?"

The story, which failed to quote any HME providers or industry leaders, could serve as a wake-up call to the industry that it's time to ramp up anti-fraud efforts and spread the word about what HME does, said Mark Higley, vice president of development for VGM.

"Someone should have the opportunity to provide information (about HME)," he said. "We are not a bunch of crooks."

While VGM alerted its members to the story, encouraging them to e-mail NPR and complain, Lopez took it a step further. He invited Allen to tour his facility and sit down and have a chat about HME. A visit is tentatively scheduled for later this month.

"I want him to see what we do, but I also want to sit down and give him the numbers and show him how valuable the service we provide actually is," said Lopez. "Let's get real."