Medicare: 'We've had enough'

Tuesday, July 31, 2007

WASHINGTON - CMS will force all home medical equipment providers in the Los Angeles area and south Florida to reapply for their billing numbers, as part of a new two-year demo project to crack down on fraud, officials announced during a press conference July 2.
In the next few months, CMS plans to send notices to about 5,000 providers in the Los Angeles area and about 2,700 providers in south Florida, asking them to resubmit form 855S within 30 days. The agency will then review the forms and conduct unannounced site visits to determine whether providers can continue billing Medicare.
Failure to reapply will result in "immediate revocation."
When asked what prompted CMS to launch the demo, Leslie Norwalk, the agency's acting administrator, said: "I've had enough."
Already, CMS has made several attempts to crack down on fraud, many of them successful. Most recently, an initiative called Medicare Strike Force resulted in dozens of arrests, including that of an air conditioner repairman moonlighting as a pharmacist prescribing inhalation medications (See HME News, May 2007).
This demo differs from previous efforts in that it attempts to stop fraud before it happens, officials said. CMS's review of applicants will still focus on the 21 supplier standards, which include having a physical presence, posted hours and appropriate staff. But it will also involve multiple unannounced site visits (not just an initial site visit) and "more aggressive background checks," officials said.
"(Our efforts have) been more reactive in the past; this is an attempt to be more proactive," said Kim Brandt, CMS's director of program integrity.
If the demo goes well in Los Angeles and south Florida, CMS will expand it to other areas, officials said. If the agency learns that unscrupulous providers are moving to other areas to avoid scrutiny, "We would follow them," Norwalk said.
To conduct the demo, CMS will reallocate resources to put "more feet on the street." Officials wouldn't say how many additional investigators it will deploy, only that the number would increase substantially.
"The point is to have additional resources to go after this," Norwalk said. "Ultimately, the amount of money that you save the (Medicare) trust fund--the return on investment--is huge. It's hard to overestimate what we would save."
To put the overall goal of the demo into context, Norwalk described a recent site visit to Faster Medical Equipment in Miami.
"When the agents arrived at the location, they found little other than a small closet," she said. "There was no clinic; there were no patient files. What they did find: buckets of tar, a broken oxygen machine and so on. The owner of this company used taxpayer dollars funded by Medicare to buy a Rolls Royce.
"It is absolutely appalling that this is happening," Norwalk continued.