WASHINGTON – Medicare officials announced on July 2 a new effort to combat fraudulent billing in two areas of the country where bilking the public program seems to be prevalent.
Durable medical equipment suppliers in South Florida and the Los Angeles area will be required to reapply for their contracts with Medicare, the U.S. Department of Health & Human Services announced.
To maintain their current billing privileges, suppliers must reapply within 30 days of receiving a letter of notification from the Centers for Medicare & Medicaid Services. DME suppliers will lose billing privileges if they fail to disclose a change in ownership or address, or if any of their owners, partners or managing employees have committed a felony in the past 10 years.
CMS officials say they also will visit DME companies in the two regions to ensure that suppliers meet all guidelines stipulated by their Medicare contracts.
“Enhancing our review of these suppliers will go a long way to ferret out those who do not meet the needs of beneficiaries and the promises of Medicare,” Leslie Norwalk, acting administrator of CMS, said in a press release.
Kim Brandt, CMS’ director of program integrity, said at a press conference that the agency’s previous approach to fraudulent billing was largely reactive. “This is an attempt to be more proactive,” she said.
The reapplication order will be in place for two years.
A Medicare “strike force” assembled earlier this year and made up of federal, state and local enforcement personnel has netted 56 arrests in South Florida on charges including conspiracy to defraud Medicare, criminal false claims and violations of anti-kickback statutes.
Since the recent crackdown on Medicare fraud, 634 supplier billing numbers in South Florida and 770 billing numbers in California have been revoked. CMS estimates savings of more than $317 million as a result of staving off fraud in Florida alone.
Michael Reinemer, vice president of communications and policy for the American Association for Homecare, said the trade organization is pleased to see CMS taking these steps.
“Our concern for many years has been that it’s been too easy to get a Medicare supplier number, which in some cases has essentially been a license to steal from taxpayers,” Reinemer said. “We’re happy that CMS is instituting safeguards at the front end of this process. By requiring them to resubmit and by doing these site visits, they should make sure that none of these criminals are setting up the storefronts that have given the entire industry a black eye.”