Senator to CMS: No more HME supplier numbers

Thursday, December 9, 2010

WASHINGTON - Sen. Ron Wyden, D-Ore., blindsided the HME industry earlier this month when he sent a letter to CMS, urging the agency to temporarily stop issuing new HME supplier numbers as a way to control fraud and abuse.

In his two-page letter to CMS Administrator Donald Berwick on Dec. 3, Wyden wrote: "Limiting the enrollment of new DME suppliers will go a long way in assisting CMS' fraud and abuse prevention activities. This will assist CMS in ensuring that suppliers billing Medicare are compliant with the standards and the criteria required to obtain and retain their billing privileges."

The industry's response to the letter: Nonsense. If CMS can't control fraud and abuse, it's due to the agency's own incompetence. CMS bureaucrats have new supplier standards, a surety bond requirement and plenty of other tools at their disposal to do that, said numerous stakeholders.

"It's ridiculous," said Cara Bachenheimer, Invacare's senior vice president of government relations. "CMS has accreditation, and they are supposed to be going out and physically inspecting providers. Has CMS somehow said they are incapable of doing that? Because that is what the message is."

Wayne Stanfield couldn't agree more.

"We view this as another example of being out of touch with Medicare and the whole DME benefit," said the executive director of the National Association of Independent Medical Equipment Suppliers (NAIMES).

Wyden's letter puzzled industry stakeholders, who say it came out of the blue. There's no current OIG, GAO or other government study circulating that highlights a need to crack down on DME fraud and abuse. In fact, in his letter, Wyden cites a 2007 OIG study that addresses improper DME claims payment. That study occurred before CMS rolled out accreditation and other fraud fighting tools and "doesn't currently reflect what is taking place in the HME segment," said Walt Gorski, AAHomecare's vice president of government affairs.

What's more, the letter includes a number of misleading statements. For example, Wyden states that nearly 100,000 HME providers now participate in the Medicare program. While Medicare recognizes that many active DMEPOS supplier numbers, only about 20,000 belong to HME providers. The rest belong to pharmacies, O&P companies and other kinds of providers, Gorski said.

AAHomecare has tried to contact Wyden to discuss the letter but so far has had no luck, he said.

"The association has no tolerance for fraud and abuse," Gorski said. "But unless there is a documented need for such a moratorium, we don't believe it is necessary. There has to be an extraordinary circumstance to pull the trigger on freezing supplier numbers. At the end of the day, CMS needs to do a better job policing."



Ron Wyden proves the point of my favorite joke. If the governemnt is the answer, then it must be a really stupid question.