Medicare Has Failed To Combat Fraud Effectively, Says American Association For Homecare

The American Association for Homecare restated today that the homecare industry, which provides medical equipment and therapies in the home, supports stepped-up efforts to crack down on Medicare fraud and looks forward to continuing work with federal agencies and Congress to prevent fraudulent activity. At the same time, the Association said Medicare has failed to effectively exercise its already ample authority to combat fraud and abuse.



"Medicare and its private sector contractors must vastly improve their approach and do a better job at insisting on standards and other up-front controls that will deny illegitimate operators any chance of taking advantage of the Medicare program," stated Tyler J. Wilson, president and CEO of the American Association for Homecare. "Accreditation and tightened restrictions on entities that are allowed to obtain billing privileges will go a long way toward establishing an environment where unscrupulous companies cannot operate."



"We have been at the forefront of efforts to prevent fraud, which is why the homecare industry supports accreditation, quality standards, and other steps to help stem illegal activity. Medicare has failed to impose up-front measures that will curb the opportunity for fly-by-night operators to rip off Medicare," Wilson said. "Existing regulations give Medicare ample authority and tools to address the issue. The American Association for Homecare strongly advocates for ethical participation in Medicare and also for clear, up-to-date, and fair federal regulations that target fraud and abuse but that do not unduly burden those providers who make every effort to follow the rules."



The Association says the vast majority of homecare companies are owned and operated by law-abiding individuals. In many cases, these firms are family operations involving multiple generations, who are dedicated to providing the best possible therapies and medical equipment to treat and improve medical conditions for patients at fair prices. Homecare providers serve patients who suffer from a variety of conditions ranging from multiple sclerosis and congestive heart disease to chronic obstructive pulmonary disease (COPD).



Earlier this year, the American Association for Homecare offered suggestions to congressional committees for addressing fraud and abuse:



-- First, the Association has endorsed the federal quality standards and accreditation requirements for home medical equipment required by the Medicare Modernization Act of 2003 (MMA) and has worked closely with CMS along the way to develop those quality standards. In fact, last year the Association recommended that CMS adopt standards that were far more stringent than what the agency adopted in its final standards issued in November 2006. Many of the requirements from the MMA are only now nearing implementation. Medicare coverage, coding, reimbursement and documentation policies as well as standards for quality, should be clear and unambiguous.
















-- Second, the Medicare program has numerous anti-fraud and abuse safeguards in place that must be more effectively enforced. Currently, the Medicare program requires that suppliers adhere to specific standards in order to obtain and maintain billing privileges. Proper enforcement of the current rules along with new quality standards and accreditation will go a long way toward cracking down on criminal activity. For example, Medicare and its contractors currently have the ability to conduct on-site inspections to ascertain the provider's compliance with the supplier standards. The National Supplier Clearinghouse (NSC) is also required to conduct on-site inspections when it issues a new supplier number and every three years upon renewal. Shell companies that are purposefully out to defraud the Medicare program should not be able to pass these unannounced site inspections.



Home medical equipment and therapies provide a critically important benefit that serves millions of beneficiaries. Secretary Michael Leavitt has called for greater use of home- and community-based care in Medicaid because "it's not only where people want to be served, but it's radically more efficient."



The American Association for Homecare (AAHomecare) represents providers, equipment manufacturers, and other organizations in the homecare community. AAHomecare members serve the medical needs of millions of Americans who require oxygen equipment and therapy, mobility assistive technologies, medical supplies, inhalation drug therapy, home infusion, and other home medical equipment, therapies, services, and supplies in the home. Membership reflects a broad cross-section of the homecare community, including providers of all sizes operating approximately 3,000 locations in all 50 states.



American Association for Homecare

2011 Crystal Drive, Suite 725

Arlington, VA 22202 703-535-1881

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