Sen. McCaskill on fraud: Enough blame to go around

Friday, April 26, 2013

WASHINGTON – Both the HME industry and CMS came under fire April 24 during a congressional hearing to review provider business practices and Medicare audits.

The hearing was the first for the Subcommittee on Financial & Contracting Oversight, which is led by Sen. Claire McCaskill, D-Mo.

“One significant concern is the prevalent practice among some medical equipment companies to aggressively call, email and write Medicare beneficiaries to directly market their products,” McCaskill said, citing a doctor from Chesterfield, Mo., who was recently “besieged by faxes from companies asking her to sign prescriptions from these patients so that the companies can bill Medicare.”

Two HME providers—Jon Letko, president of Milford, N.J.-based U.S. Healthcare Supply; and Dr. Steve Silverman, president of Boca Raton, Fla.-based Med-Care Diabetic and Medical Supplies—were invited to testify but declined. AAHomecare submitted a statement for the record.

“I continue to believe that these companies can provide us useful information that would assist the subcommittee in its oversight,” McCaskill said. “We will continue to discuss the possibility of these witnesses appearing in front of us at a future date.”

In the latter half of the hearing, McCaskill, a former auditor herself, took CMS’s auditors to task for recovering only $34 million of roughly $10 billion in improper payments identified in 2011.

“How much of their contract is based on how well they do and how much of it do they get regardless of whether or not they’re complete failures at it?” she asked.

Testifying at the hearing were two representatives from CMS: Peter Budetti, deputy administrator and director of the Center for Program Integrity; and Laurence Wilson, director of the Chronic Care Policy Group. When McCaskill asked for data separating improper payments due to fraud versus those due to technical errors, Budetti could not supply the information.

“The way that the statistical sample is structured and the way that it measures improper payments is not a very sensitive tool in terms of actually looking at fraud,” he said.

McCaskill was not satisfied with Budetti’s response.

“Well then why do we have it?” she asked. “Why are we auditing anything?”