The American Association for Homecare has announced 13 recommendations designed to combat Medicare fraud attributed to the home medical equipment (HME) sector.
"The homecare sector has zero tolerance for illegal activity, and we are frustrated that the problem seems to be growing rather than shrinking," said Tyler J. Wilson, president and CEO of the American Association for Homecare. "Taxpayer dollars lost to fraud represent theft of resources needed by seniors and people with disabilities."
The recommendations made by the AAH consist of:
- mandatory site inspections for all new HME providers;
- required site inspections for all HME provider renewals;
- improved validation of new homecare providers;
- two additional, random, unannounced site visits for all new providers;
- a six-month trial period for new providers;
- the establishment of an anti-fraud office at Medicare;
- post-payment audit reviews for all new providers;
- real-time claims analysis and a refocus on audit resources;
- assurances that all providers are qualified to offer the services they bill;
- the establishment of due process procedures for suppliers;
- increased penalties and fines for fraud;
- and more rigorous quality standards.
"Because the home is the most cost-effective setting for healthcare, home-based care is a key part of the solution to the nation's healthcare crisis and to Medicare reform," Wilson said. "Wise use of home medical equipment and therapies will help rein in spiraling costs."
Earlier this year, the American Association for Homecare recommended to Congress several anti-fraud measures that were incorporated into the Seniors and Taxpayers Obligation Protection (STOP) Act of 2008, S. 3164, which was introduced on June 19, 2008, to reduce Medicare fraud.
On July 15, Congress enhanced fraud prevention by strengthening a statutory mandate for accreditation of home medical equipment providers and closing a loophole that would have allowed non-accredited providers to provide services to Medicare beneficiaries. The Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) mandates a September 30, 2009 deadline for accreditation of all home medical equipment providers nationwide.