Audits, anarchy and sticky fingers


This week marks the 95th anniversary of the Boston Molasses Disaster. That's when a storage tank exploded sending a wave of the sticky stuff, sometimes reaching 25 feet in height, at 35 mph through the North End. Buildings were knocked off their foundations and crushed.

An excerpt from a Boston Post story at the time reads "Molasses, waist deep, covered the street and swirled and bubbled about the wreckage ... Here and there struggled a form—whether it was animal or human being was impossible to tell. Only an upheaval, a thrashing about in the sticky mass, showed where any life was ... Horses died like so many flies on sticky fly-paper. The more they struggled, the deeper in the mess they were ensnared. Human beings—men and women—suffered likewise."

OK, so the news story is a bit overwrought but doesn't all this make you think of competitive bidding and audits? Ensnaring HME providers in their evil wake? Knocking decades old businesses—indeed the very foundations of the industry—off its collective foundation?

This week we will start on the March issue. The first story I am tackling is the backlog of ALJ appeals (speaking of molasses). No fewer then three people so far have alerted us to a memo from the Office of Medicare Hearings and Appeals.

According to the memo, in January 2012, the OMHA central office received about 1,250 appeals each week. In December 2013, that number was—wait for it—15,000 per week. 15,000! The OMHA has a backlog of 357,000 claims and 65 ALJ judges. (I should note, these aren't just HME appeals). That's nearly 30,000 cases per judge. I guess we can all see why they have suspended assigning new hearing requests. 

I can think of one way to catch up on this backlog: suspend the damn audits. I mean, the fact that there are so many appeals only underscores that the auditors are denying claims based on, as one provider put it to me, being submitted on the wrong color paper. This comes as no surprise to the industry which has all along said that the practice of paying auditors for finding mistakes would create a bounty system in which they get their sticky little fingers into everybody's files. The system is broken and, to add insult to injury, people are being denied due process. I mean, last I checked, this is America, no?

Back to the owners of that exploding molasses tank. They blamed it on anarchists (a claim never borne out).

Audits? Anarchy? You be the judge.

Theresa Flaherty



What can the industry do about this?  NOTHING, ZERO, NADA!!! 

Why?  Because the industry chose NOT to fight for Court Reform and allowed The Third Circuit Decision to remain in place.  Now the industry remains with NO venue of jurisdiction for complaints outside the very Court creating the debacle.  Wow!! 

The Third Circuit Opinion washes the Federal Courts hands of having any jurisdiction to hear ANY/ALL arguments referrencing complaints of CMS, its' employees or contractors as agents of the government!! 

MMA 2005 extends that entire jurisdiction to the then newly created CMS ALJ Courts. Then to compound the unimaginable if possible The CMS ALJ Court only has jurisdiction for determining benefits to be paid!!

This resulting Autonomy by CMS was ALL spelled out in previous postings!!!

Forget CB and Audits; the industry NEEDS Congress to pass legislation for Federal Court Reform a "Court Of Jurisdiction"!!