A major FEAT: Solving the fraud crisis

Sunday, November 2, 2008

YARMOUTH, Maine - A new group of industry stakeholders plans to take a collaborative approach to combating HME fraud and abuse.

In October, the Fraud Eradication Advisory Team (FEAT), an advisory council of industry leaders and consultants, began brainstorming strategies for reversing a tidal wave of negative attention in the media. To attack the problem, it wants all hands on deck, including CMS and its contractors.

"It really is almost at a crisis level for the industry," said Wayne van Halem, principal of WVH Consulting and one of FEAT's executive team members. "We can blame CMS all we want and CMS can blame providers all they want, (but) we're trying to collaborate and move forward. In order to accomplish that, everyone has to take some responsibility."

Members envision FEAT as a sounding board for everyone from state associations to advocacy groups to manufacturers to providers to share input with CMS about beefing up its inspection process or requiring background checks. Another component: encouraging self-policing.

Providers support the idea, members say.

"We're hearing from providers who are saying, 'We do need licensure by the state,'" said John Gallagher, vice president of government relations for the VGM Group and a FEAT member. "That way, you would have providers on a pharmacy board or DME board who have investigatory power so if fraud is identified, that individual would lose their state licensure and very quickly their Medicare number.

"Many providers know where (fraud is) and they spend years and years trying to get someone to look at it," he said.

One area the group doesn't plan to target is legislation, which is an area AAHomecare is pursuing, van Halem said. An AAHomecare representative is working with FEAT, in hopes that the groups can share ideas, but not duplicate their efforts.

FEAT's first goal is to get CMS and its contractors to join the conversation, because everybody has a black eye, members said.

"We hope to sit down and say, 'Here are our concerns; what are your concerns?'" Gallagher said. "So it's not an 'us vs. them,' but how we can work together to eradicate fraud."