The HHS Office of Inspector General (OIG) released two reports today examining the compliance of Medicare DMEPOS suppliers with selected Medicare supplier standards. If asked, AAHomecare's interpretation of the findings would be that the OIG found that Medicare and its contractors are lax in enforcing supplier participation requirements. Unfortunately, the likely message heard by CMS and by those on Capitol Hill is that the DMEPOS benefit is rife with unscrupulous suppliers and more than a few bad apples are not following Medicare's established rules. These reports damage our credibility on Capitol Hill and at CMS.
The recommendations by the OIG in the first report include:
Because nearly half of the suppliers we visited were not in compliance with the Medicare supplier standards we reviewed, our findings warrant further attention by CMS to protect the integrity of the Medicare DMEPOS benefit. Therefore, we recommend that CMS:
Strengthen the Medicare DMEPOS Supplier Enrollment Process and Ensure That Suppliers Meet Medicare Supplier Standards
Options to implement this recommendation could include:
- conducting more unannounced site visits to suppliers;
- implementing an enhanced review of all new enrollment applications by DMEPOS suppliers in South Florida;
- prioritizing processing reenrollment applications for current suppliers over processing new supplier applications;
- performing more rigorous background checks of applicants;
- assessing the fraud risk of suppliers and targeting monitoring and enforcement on high-risk suppliers;
- increasing prepayment review of DMEPOS claims;
- requiring all DMEPOS suppliers to post a surety bond;
- implementing a competitive bidding acquisition program for DMEPOS within high-vulnerability areas; if a competitive bidding program is implemented in these areas, the number of suppliers should be limited to those that demonstrate compliance with Medicare standards and that can provide the best value to the Medicare program and its beneficiaries;
- requiring suppliers in areas particularly vulnerable to fraud and abuse to reenroll with NSC more frequently than every 3 years;
- strengthening the Medicare supplier standards by establishing a minimum number of hours of operation required for each supplier and establishing minimum inventory requirements for product and service types provided by a supplier; and
- deactivating the Medicare billing numbers of DMEPOS suppliers that have been inactive for a 90-day period.
The second report strongly encourages CMS to conduct out-of-cycle site visits. It also highlighted the methodology that the OIG used to target suppliers for out-of-cycle site visits through specialized data mining (use of Clementine® software) and billing pattern data. While the suppliers that the OIG visited were not representative of the HME community at large, the OIG's report could be interpreted by policymakers that while out-of-cycle site visits must be conducted, other efforts need to be made to ensure compliance with Medicare's supplier/quality standards.
In response to the second OIG report, CMS indicated that it is drafting a proposed regulation addressing the posting of surety bonds; enhancing the number of unannounced site visits; and developing a proposal to revise deactivation requirements for inactive Medicare billing numbers. |
