If you think Medicare’s fraud and abuse efforts are limited to unmarked and unmanned HME storefronts in Hialeah, Fla., think again.
Steve Palacioz is the owner of Advanced Medical Concepts in Wichita, Kan., which bills Medicare about $1 million per year for walkers, wheelchairs and hospital beds. For going on 20 years, he’s operated his DME company from an office in his home. The office has a dedicated door with posted hours of operation. His accreditation was renewed by HQAA this summer.
None of this, however, stopped Medicare officials from visiting Palacioz in March, August and September of 2012, the last visit resulting in a letter notifying him that his supplier number had been revoked.
“They said I wasn’t staffed,” he said. “We’re a two-person operation: me; my son, who is the delivery person; and my wife, who is almost always home. There’s no leeway in the standards.”
Those standards, implemented in 2010, require, among other things, that providers have a physical facility that’s staffed during posted hours of operation.
Even though Palacioz had his cell phone number posted to the door—a number Medicare officials didn’t bother to use—that’s not enough, says Neil Caesar, president of the Health Law Center in Greenville, S.C.
“They want a warm body,” he said.
While business setups like Palacioz’s are less common, they can be done within the law, says Mary Nicholas, executive director of HQAA.
“There have been single-person operations that we’ve dealt with where they’d do the required 30 hours of operation, but they give themselves a three-hour noon hour to do deliveries, and they post hours until 7 p.m.,” she said.
Now Palacioz is working through the maze-like process of getting his supplier number back. He plans to respond to Medicare within the required timeframe, explaining that he will adjust his hours of operation.
Caesar recommends that Palacioz be “relentless” on his company’s behalf.
“You have to be proactive about this, because communication and verification with the NSC can be difficult,” he said.
That’s what Palacioz plans to do, but he can’t stop feeling like Medicare is making much ado about nothing.
“Why am I getting hassled,” he said.
The take-away, here, for all providers, Caesar said: “These standards may be old, but they can still nail you.