Look for fraud investigators to target smaller HMEs

Sunday, March 31, 2002

ORLANDO, Fla. - To get out of bankruptcy, Rotech Medical agreed to pay the federal government $17 million for allegedly improperly billing Medicare.

Last year, American HomePatient and Lincare settled similar charges for $7 million and $3.15 million, respectively. The feds are also investigating Apria for possible billing improprieties. With the nationals more or less out of the way, look for investigators to now train their attention on smaller HMEs, say industry watchers.

"CMS has been throwing resources at big companies because they are fewer in number," said healthcare attorney Tom Antone of the D.C. law firm Mintz, Levin. "But they are going to be entering a phase where they will increase scrutiny of smaller companies."

Federal officials began investigating the nationals four or five years ago, and while most large companies have now implemented compliance plans in an effort to head off potential billing problems, that's not so with many mom and pops, Antone said.

"Their concept is too often not the big picture, and they tend to minimize or not even think about the potential consequence of what they are doing or not doing by not putting in a compliance plan," Antone said. "They assume that because I'm getting paid, everything is OK."

It's not, said Antone and others.

"The size of a company is not necessarily material in whether the government comes looking for your paperwork," said Baltimore healthcare attorney Ann Berriman. "The theory was, 'We're doing it right sometimes, and we try and we know what the right rule is. It's just really hard to make people do it that way every single time.' You can't afford to have that attitude anymore. No one can. No matter how big or small you are." HME