Home Health & Hospice Week

Contractors are violating the law, power mobility industry charges.

If you're a supplier of power mobility equipment who has received a letter recently informing you that you're the target of a post-payment audit due to utilization levels, take heart in knowing that you're not alone - and that there's an organization looking into the audits' legality.

In recent weeks, durable medical equipment regional carriers have sent such letters to several large and medium-sized suppliers, reports Executive Director Eric Sokol of the Washington-based trade group Power Mobility Coalition. Sokol raised concerns about the audits publicly during the June 23 Home Health, Hospice and DME Open Door Forum sponsored by the Centers for Medicare & Medicaid Services.

John Warren of CMS' Program Integrity Group told the forum he had no comment on the matter. Moderator Dr. Richard Lawlor noted that CMS is working with "a lot of groups" about power mobility reviews in general but offered nothing specific about the letters.

Audits May Violate Paperwork Reduction Act

"There are a couple of things that are disturbing about these letters," Sokol tells Eli. "First of all, they're based solely on utilization levels." For example, the letters give as the basis for the audit the fact that the supplier is X out of 100 in terms of utilization, Sokol reports.

In addition, the letters state that contractors will review a sample of claims and extrapolate over the universe of claims during the audit period. The Medicare Modernization Act limits extrapolation to those circumstances where there is an unusually high or sustained level of payment errors.

Further, the PMC maintains that the effort is a general investigation and thus violates the Paperwork Reduction Act. The DMERCs' demand for documentation is also in violation of the PRA, Sokol charges.

"We have concerns over what we feel is an inappropriate and illegally targeted general investigation of power mobility suppliers based solely on utilization," says Sokol. "There's no evidence of fraud, no beneficiary complaints. These letters were generated solely based on utilization."

Sokol is discussing what steps the organization might take with PMC Attorney Stephen Azia.