State keeps lid on Medi-Cal supplier numbers
SACRAMENTO, Calif. - Since 60 Minutes embarrassed California's Department of Health Services with an expose on fraudulent providers in 1999, the state has kept the lid on Medi-Cal supplier numbers.
On April 13, the department's Office of Regulations extended the moratorium for another 180 days, despite the opposition of the California Association of Medical Product Suppliers. CAMPS submitted a number of suggestions that would enable Medi-Cal to raise the bar on participation in the program.
CAMPS has suggested that Medi-Cal require suppliers to have some form of recognized accreditation, contracts with private payers and some measurement of operating history. Would-be Medi-Cal suppliers have expected to see the regulations in January, then again in April and now this month.
A spokesman for Medi-Cal said the program is now reviewing four separate regulation packages.
"I'm saying, simply produce the parameters, said Jim Leedom, a co-owner of Home Health Depot in Culver City, Calif. "Don't withhold them. Tell me what to shoot for. You're not even giving me an opportunity to find the bar, much less get to it."
Medi-Cal said it has 800 active HME suppliers on its books today. Before the moratorium went into effect, Leedom said Medi-Cal was serviced by 1,400 suppliers. (More than 8,800 Medicare supplier numbers are now active in California, according to the National Supplier Clearinghouse.)
The only other way into Medi-Cal is through the purchase of an existing supplier number or as a rehab provider, a frustrating predicament for Leedom, who has been sitting on the sidelines for two years.
"The number of providers who have a license are dropping, and everybody else is getting a bigger piece of the pie," said Leedom.
That's fine with at least one California HME provider: "We've seen so many fraud scams on Medi-Cal over the last 10 years or so, and the crooks disappear into the woodwork, leaving the honest dealers to take the blame. As far as I am concerned, the state should not issue another provider number until they are 100% certain that they've conquered the fraud problem. If that takes years - and it will - so be it."
No one can explain why it's taking Medi-Cal so long to come up with new regulations. Some say that as long as the moratorium is in place, Medi-Cal is inadvertently preventing more fraud. Since access doesn't seem to be a problem, Medi-Cal doesn't seem to be anxious to open the doors.
"The department thinks that once the moratorium is lifted, the bad apples will show up again," said CAMPS Executive Director Bob Achermann. HME