Peggy says...'mistakes vs. fraud'

Tuesday, December 23, 2014

The Washington Post recently published an article on power wheelchair fraud as the first in a four-part series detailing problems in the Medicare system. As with a number of media pieces in the past, this article’s focus on the inattention of the Medicare contractors makes the DME community appear to be crawling with scam artists. However, as an industry we know that it is the very few who are actually “intentionally” billing for items they did not provide or providing items that are not truly medically necessary. In addition, most of the examples reported in the article are “ancient history,” taking place prior to “Operation Wheeler Dealer” and CMS’s policy changes in the mid-2000’s.

Unfortunately, regardless of what the item is or how it is coded, there will always be scammers out there. As an industry, we consistently warned Medicare of what was happening in the past but they ignored the complaints and blindly carried on. This resulted in significant loss of dollars from the Medicare Trust, despite the fact that the contractors were hired to protect this fund.

The wolf was in the hen house and no matter how many chickens squawked and lost their feathers, Medicare contractors just turned their heads.

 Once they woke up, they started roasting the chickens while the wolf slunk away.

The supplier community will see (and has seen) a turn for the better, and we need to ignore the “past” actions of unscrupulous providers. Their time is up and what happened in 1995 and after is gone. Most of what is mentioned in the article is water under the bridge. The pendulum is swinging and Congress is seeing that Medicare contractors are falling far short of their jobs.

We, as suppliers, need to stay focused on the here and now. Continue to fight the Competitive Bidding Program issues. Let your legislators know this is not acceptable. Tell them that they need to stop the continued abuse of Medicare contractors’ powers over our claims processing and that the audits need to address real issues and not mistakes. Mistakes are NOT fraud. Fraud is intent!

Peggy Walker, RN and your Reimbursement Team at VGM/US Rehab. 800-401-3643.