NSC takes ‘draconian’ approach to compliance

Saturday, January 31, 2004

COLUMBIA, S.C. - The National Supplier Clearinghouse, apparently in a full-court press to reduce Medicare fraud and abuse, has begun revoking the provider numbers of HMEs who deviate even slightly from the 21 supplier standards.
Industry watchers have no problem with making providers adhere strictly to the supplier standards. What irks them is the NSC’s unresponsiveness to providers who attempt to rectify their shortcomings within the allowed 15 days.

For example, the NSC regularly fails to acknowledge documents demonstrating compliance provided before the deadline, sources say. When that happens, the HME’s Medicare provider number is revoked.

Additionally, many of the infractions are minor and easily fixed: a provider isn’t listed in the Yellow Pages or needs to show additional documentation that he has insurance.

“What we have is a draconian approach to compliance,” said Neil Caesar, president of the Health Law Center in Greenville, S.C. “I’m not saying they are not supposed to do it that way, but supplier standard regulations contemplate two remedies to offset that heavy-handed approach. One, there is an opportunity to fix things before the effective date. Two, there is a quick opportunity to be heard via a hearing. Neither is being granted.”

The NSC did not return phone calls for this story.

The NSC embarked upon its aggressive enforcement last fall, following the Wheeler Dealer power wheelchair scandal in September, say industry watchers. Crooks in the Harris County scam, which defrauded Medicare of millions of dollars, had no problem securing provider numbers, an NSC official told HME News in October.

The current NSC unresponsiveness appears due to a failure in workflow or an inability, due to a lack of manpower, to handle the stepped up enforcement efforts.

“To make sure providers comply is good, but the procedure they are using is unfair and inefficient,” said healthcare attorney Everett Wilson, managing partner with Wilson Suarez Lopez & Gennett in Coral Gables, Fla. “They are creating a problem for themselves by terminating folks and not giving them enough time to prove themselves.”

The resulting cash-flow crunch could drive a provider out of business, Wilson said.

To go through the hearing process, prove compliance and have a provider number reinstated takes about two months, said Wilson, adding that the process seems to be speeding up.

There is a rationale for the stepped up NSC enforcement. Civil and criminal investigations can take years. Shutting off a supplier number takes 15 days, said Jeff Baird, a healthcare attorney with Brown & Fortunato in Amarillo, Texas.

“The NSC can shut down the bad providers more quickly, but there are always some legitimate providers who get caught up in the same net,” Baird said. “We are handling quite a few of these fights right now. If the supplier is an honest player, then the DMERCs and NSC will work with us. If the client is a sham, and usually we won’t take them on if they are, they don’t have a chance.”