NPR takes second look at DME fraud

Sunday, November 11, 2007

MIAMI - Nearly a month after riling the HME industry with a story that implied rampant fraud and abuse among providers, National Public Radio (NPR) aired another side of the story Nov. 6.

Reporter Greg Allen's original story, "Medicare Fraud Acute in South Florida," made it seem as though all DME providers were running Medicare scams. Missing, said industry leaders, was the provider perspective.

Enter Raul Lopez, operations manager of Miami Lakes, Fla.-based Bayshore Dura Medical, who invited Allen to visit the company and talk about the business of Medicare fraud.

Allen toured Bayshore's facility Oct. 31, spending about two hours there, and spoke with Lopez and Bayshore owner Robert Mendia.

"I think he got a better understanding of who we are and what we go through," Lopez told HME News. "And he was able to see we've been reporting fraud issues forever and a day."

Fraud is nothing new, Lopez told Allen, citing "a long list of red flags" to which CMS seems immune.

As Lopez put it in the article: "You have patients receiving two artificial legs in a year...when they never amputation from a hospital."

Kimberly Brandt, the head of program integrity for CMS, is quoted in the article as admitting CMS hasn't traditionally gone after fraud.

"Part of that had to do with our limited resources, quite frankly," she said. "In the past, perhaps we have not been as vigilant as we could have been."

Responded Lopez: "Limited resources? That's a hoot. But, actually, having CMS on record saying they haven't been doing anything--that's a perfect lobbying tool."