OIG alert adds wrinkle to DME ordering process

Thursday, January 14, 2010

WASHINGTON - A fraud alert issued last week by the Office of Inspector General (OIG) could hamper the relationship between doctors and HME providers, say industry stakeholders.

The alert states that providers may not contact beneficiaries "based solely on treating physicians' preliminary written or verbal orders prescribing DME for the beneficiaries."

Historically, that's how it's always been done, said Jeff Baird, a healthcare attorney with Brown & Fortunato in Amarillo, Texas.

"If the physician feels Mr. Smith needs DME, he calls, faxes or e-mails the order to the DME," said Baird. "The DME then picks up the phone, calls Mr. Smith and makes the arrangement. The OIG has said you can't do that anymore."

According to the original March 2003 statute, HME providers may only contact Medicare beneficiaries in three circumstances: 1). The beneficiary has given written permission to the supplier to make contact by telephone; 2). The contact is regarding a covered item that the supplier has already furnished the beneficiary; or 3.) The supplier has furnished at least one covered item to the beneficiary during the preceding 15 months.

The statute makes it clear that providers cannot engage in unsolicited telemarketing.

"But, it's not intended to prevent physicians from faxing in an order," he said. "That's just poppycock."

The OIG alert displays a lack of understanding of the working relationship between physicians and HME providers, according AAHomecare.

"A workable system under Part B has to reflect the way the real world operates and how patients, physicians and HME suppliers interact," stated President Tyler Wilson in a release. "This latest OIG fraud directive completely misunderstands effective fraud controls already in place and how the typical Medicare beneficiaries expect to receive homecare products."

AAHomecare is in the process of drafting a response that will be sent to CMS and the OIG.

At any rate, the alert should put the industry on notice, said attorney Neil Caesar, president of the Health Law Center.

"The OIG only issues these alerts when they are aware of abuses and intend to pursue investigations," he said. "Notwithstanding that this thing is talking about phone calls, I think we can expect scrutiny for Internet and in-person solicitations."