Stakeholders push for targeted, measured fraud-fighting efforts

WASHINGTON – Industry stakeholders VGM Group and AAHomecare have submitted comments on a request for information (RFI) from the Centers for Medicare & Medicaid Services (CMS) on Comprehensive Regulations to Uncover Suspicious Healthcare (CRUSH).

VGM says its comments reflect its support of CMS’s goal of strengthening program integrity and its shared goal of protecting Medicare beneficiaries and taxpayer dollars from fraud, waste and abuse.

The organization’s recommendations include:

• Strengthening DME MAC oversight authority over new providers.
• Improving quality of site visits with inspector training program.
• Promoting e-orders.
• Improving cross-program enforcement.
• Improving Medicare Advantage oversight by requiring providers enroll in PECOS.
• Implementing mandatory Targeted Probe and Educate (TPE) for new suppliers.
• Levering technology for “real-time” claims reviews.
• Expanding prior authorizations.

Read VGM’s submitted comments here.

In its comments, AAHomecare emphasized that to ensure fraud-fighting efforts are successful without inadvertently harming patients and the legitimate DMEPOS supplier community, CMS needs to adopt a more nuanced approach that targets at-risk and bad actors while minimizing the administrative burden on ethical suppliers.

The association’s recommendations include:

• Enhancing provider enrollment requirements for new suppliers by implementing a robust identity verification and authentication process.
• Improving the audit program by placing all new suppliers into Targeted Probe and Educate (TPE).
• Improving cross-program communication and enforcement.
• Promoting technology solutions like e-ordering, data-sharing and real-time verification.

Read AAHomecare’s comments here.