CMS weighs in on bid data
BALTIMORE - No sooner had Prof. Peter Cramton released a report that showed 60% to 80% declines in Medicare claims for home medical equipment in Round 1 competitive bidding areas (CBAs), than CMS was dismissing the data.
At a Jan. 25 Jurisdiction C council meeting, Medical Director Dr. Paul Hoover said he hasn't seen any such decline in claims, according to Michael Hamilton, executive director of the Alabama Durable Medical Equipment Association, who attended the meeting. Hoover suggested that perhaps Cramton didn't ask "the right questions" in his Freedom of Information Act (FOIA) request for the data, said Hamilton.
"He said if you don't ask the right questions you get misleading data," he said. "It seems to me it would be a pretty simple process for somebody as experienced at statistics as Cramton must be."
In addition to Hoover, CMS officials have acknowledged "some decline" in claims; they attribute it to reduced Medicare fraud.
When contacted by HME News, CMS officials wouldn't specify a percentage decline in claims or explain why they believe Cramton's report is flawed. It did release a comparison of allowed charges in CBAs versus non-CBAs as proof that the program is necessary to reduce fraud. According to CMS: In Miami, which has 517,370 fee-for-service beneficiaries, there were allowed charges of $221,660,443, or $428.44 per beneficiary; by contrast, in Chicago, which has 1,085,254 beneficiaries, there were allowed charges of $173,922,952 or $160.26 per beneficiary.
Some industry associations are asking the Government Accountability Office (GAO) to investigate the "anomaly" between Cramton's and CMS's conclusions.
"They're using the same data and both sides can't be right," said Wayne Stanfield, president and CEO of NAIMES. "We have no reason to believe that Dr. Cramton would jeopardize his reputation by putting out something that he did not have ultimate confidence in."