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If it's not bidding, it's audits

If it's not bidding, it's audits

I know Round 2 of competitive bidding is at the forefront of most of our readers' minds. Reading the responses of the latest HME NewsPoll, the news is terrible, although not surprising. Things are not going well (see Liz's story).

Still, with all the difficulties there, all the confusion and patient access issues, stakeholders I've talked to recently still have a lot to say about the ever-present headache of audits.

The accounts are outrageous—audits on old wheelchairs provided to people who are now dead; audits on commodes provided at the same time as walkers; issues with “illegible” physician signatures; approving some but not all parts of a power wheelchair; and, like Liz recently covered, audits because of incarcerated Medicare patients.

Still, a recent phone call with Greg Packer at VGM's U.S. Rehab took me by surprise.

He said he's hearing about claims that have already been audited getting hit a second time.

“We've heard about the SMRC coming in and re-auditing claims—is this what you're talking about?” I asked him.

“Sometimes,” he said. “Other times, people are getting prepay audits, then the RAC is coming in later.”

Here comes the crazy (er?) part:

“We're seeing claims people won after going all the way to the ALJ getting re-audited,” he said.


“Yes, and we've seen that in more than one pace. It's alarming.”

Alarming is right. Not does it boggle my mind that CMS doesn't trust the decisions of the administrative law judges, it's a waste of time and resources—on both the provider and CMS's part.

“If Congress doesn't know about this, they should,” Packer said.

One gentleman who had a claim that was green-lighted by an ALJ get re-audited is trying to let Congress know—speaking out on VGM's Check out the video here. Share your stories, too, while you're over there. The point of the site is to compile stories for lawmakers to see, and hopefully bring about some change.


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