Provider's proposal: Limit billing for new providers

Thursday, December 17, 2009

Provider John Mishasek has a plan to curb Medicare fraud and abuse.

He wants Medicare to limit the amount of billing new providers can do during their first year in business: $15,000 for the first three months, $20,000 for months four through six, and so on.

Mishasek’s “line of credit” concept simply gives CMS time to weed out fraudulent claims, he says.

“The National Supplier Clearinghouse (NSC) is letting crooks into the system and giving them the ability to bill unlimited amounts of dollars in the first 60 days,” said Mishasek, owner of InVivo, a diabetes shoe provider. “They do eventually catch up to somebody who is billing (improperly). Then they shut it down but by then (the crooks) have billed $2 million.”

Establishing accounts and earning the right to increased credit is a normal part of doing business in any industry, points out Mishasek.

“It’s a simple, elegant way to solve Medicare’s inability to not give out Medicare numbers,” he said.

Mishasek in November created a fraud handout for beneficiaries.

“The hope is that some will get their feathers in an uproar and send a note to their local representative,” he said. “It seems like the time is right.”