Stakeholders challenge OIG

‘We hope they will actually look at what is actually happening to utilization’
Friday, January 16, 2015

WASHINGTON – The Office of Inspector General (OIG) says it will use Medicare claims data to review the impact of competitive bidding on beneficiary access to DME, but industry stakeholders don’t want the agency to stop there.

“If our industry is allowed to provide the information that we have been collecting for fair judgment, we are hopeful that the OIG would come to the same conclusion that the bid program has negative impacts on beneficiaries,” said Kelly Turner, director of advocacy for People for Quality Care, which has collected thousands of beneficiary complaints through a national hotline.

But the industry doesn’t have the best track record with government investigations.

A report on the Round 1 rebid of competitive bidding conducted in 2014 by the Government Accountability Office (GAO), for example, simply “parroted” CMS, stakeholders charged. It found that the number of beneficiaries decreased by about 22% in bid areas vs. 16% in non-bid areas due to overutilization, not a decrease in access.

“We hope they will look at what is actually happening to utilization,” said John Gallagher, vice president of government relations for The VGM Group. “Not utilization dropped, ergo it must have been fraud. Rather that utilization dropped because patients did not get what they needed.”

Lisa Wells, who works on Save My Medical Supplies, AAHomecare’s consumer campaign, says this is also a story that goes beyond data.

“By working directly with Medicare beneficiaries, our industry knows that quality of care is not just a numbers game,” said Wells, president of Get Social Consulting. “It also comes down to ease of access to care and the right kind of care that keeps patients informed, engaged and independent.” 

The industry does have this in its favor: The number of reports on competitive bidding is piling up, hopefully catching the eyes of lawmakers. This OIG study will be the agency’s fifth on the program.

“The OIG turning its attention to the issues surrounding competitive bidding is a big deal because it helps lend credibility to our claims and will definitely help our efforts on the Hill,” said Anna McDevitt, who also works on Save My Medical Supplies and is the president of Laboratory Marketing. “It’s no panacea but it’s undeniable progress.”