Home Health & Hospice Week

Expect more paperwork to keep your supplier number.

Take a close look at your efforts to ensure quality if you hope to survive as a Medicare certified home medical equipment supplier.

On July 2, the Centers for Medicare & Medicaid Services unveiled a new pilot program targeting fraudulent Medicare billing submitted by HME providers in Los Angeles and southern Florida.

Initially, the two-year pilot program will affect only suppliers in those two areas, but HME suppliers nationwide should take note. If the program succeeds, it is likely to go national.

Vital: The new federal effort takes a strong stance on the value of accreditation.

"Sham companies" are the prime target of the new initiative, which will strengthen requirements for new medical equipment dealers seeking to obtain medical billing numbers. Background checks will be stricter, for example.

Get Ready For Annual Enrollment

What it means to you: The program targets the industry's bad apples but it will affect others. If you have a Medicare supplier number and operate in Los Angeles or South Florida, for example, expect to be required to reapply to Medicare annually instead of after three to five years.

"We believe there are easily hundreds of millions of dollars that we can save and recover being lost from fraud and abuse," said HHS Secretary Mike Leavitt in a prepared statement.

Leavitt said that he accompanied a fraud investigation task force to South Florida in May, where he visited a two-story office building that was the address for nearly 60 medical equipment providers.

Other fraudulent practices: The CMS crackdown also targets the practice of paying low-income Medicare beneficiaries for their program numbers in order to bill the government for bogus services and providing prescribed equipment but billing Medicare for upgrades not provided to beneficiaries.

Under the demonstration, CMS will revoke a DMEPOS supplier's Medicare billing privileges when the supplier:

• fails to submit a CMS-855B application within 30-days.
• fails to report a change in ownership or ad-dress at least 30 days prior to the change's effective date.
• fails to obtain accreditation from an approved DMEPOS accrediting organization within 90 days of notification from the National Supplier Clearinghouse to do so.
• has an owner or managing employee who has had a felony conviction within the last 10 years.
• no longer meets each and every requirement necessary for enrollment as a DMEPOS supplier.