Play by the rules or not at all

Friday, October 31, 2008

Who knew the HME and financial industries had so much in common?

Sure, at first glance, they appear quite different. One is built on the backs of thousands of small businesses; the other is controlled by a powerful few. One revolves around caring for the elderly and disabled; the other exists to generate steep profits.

But in October, as Congress debated whether to approve a $700 billion bailout bill for the financial industry, I couldn’t help but wonder: How did we get here? Not whether the bailout was right or wrong, or whether it would help or not, but how did we get here? I found myself asking the same question as I read in this issue about the industry’s and CMS’s efforts to reduce fraud.
How did the HME industry get here? Well, as with our failed financial industry, it has a lot to do with a 10-letter word that begins with “R.”

In the rush to approve the bailout bill, no one, it seemed, wanted to talk about the lack of regulation that encouraged financial institutions to play fast and loose with the roofs over people’s heads. Was I the only one who felt like government officials and Wall Street execs were saying, “Give us the money now; we’ll worry about regulation later”?

In the HME industry, like the financial industry, a lack of regulation has allowed crooks to run wild. It’s been a problem for years, and it’s high time the industry embrace reasonable and enforceable regulation.

I know what you’re thinking. Many states already require providers to have licenses; Medicare will require them to be accredited in 2009. One industry stakeholder told me: “We’re not the problem. It’s Medicare that’s allowing them to do these things. There’s nothing we can do.”

There’s no denying Medicare must do a better job curbing fraud, but the industry’s incessant finger pointing is a cop out. Here’s why: In the premier issue of HME News, way back in May 1995, we published a story about North Carolina being one of the first states to require HME providers to have licenses. After 13 years of fraud becoming more and more rampant, why is the industry still holding up licensure as a good barrier to fraud? Is this the best it can do?

Mandatory accreditation-a more recent, industry-supported measure-will help, but it’s not the be-all, end-all (See letter below).

It wasn’t until this year that the industry began taking steps to fight fraud in an organized and aggressive way. AAHomecare and other industry stakeholders plan to approach Congress and CMS next year with anti-fraud measures like increased supplier enrollment standards.

The industry’s not the only one catching on to the need for increased regulation. Medicare announced recently that it plans to implement a whole host of anti-fraud measures, including expanding its recovery audit contractor (RAC) program nationwide.

While it behooves the industry to play a role in making sure any new regulations are, again, reasonable and enforceable, it does not behoove it to chafe too strongly against increased regulation. In fact, some providers would be doing themselves a favor by dropping their get-the-government-off-my-back attitude.

When you work for Medicare, you play by its rules or not at all.