Home Health & Hospice Week

If the fraud enforcement heat seems to be off home health agencies, it's still strong on durable medical equipment suppliers.

"DME always gets it" from the HHS Office of Inspector General, notes Erik Sokol with the National Association for Home Care & Hospice. And the OIG's latest semiannual report is no exception.

DME recommendations and examples that fill the report, which summarized the OIG's activities from October 2002 to March 2003, include:

Physician orders for DME should use the doc's unique physician identification number (UPIN). While the physician waits on a permanent number, a surrogate number can be used.

But in 61 percent of services the OIG reviewed, a DME order incorrectly used a surrogate number when it should have included a permanent UPIN. "Physicians, for more than a third of services, had been issued a [UPIN] at least five years prior to the dates of service on claims," the OIG says in its report.

The OIG wants CMS to perform targeted reviews of claims for inaccurate UPINs. CMS paid $61 million for services billed with surrogate UPINs that had missing or incomplete documentation in 1999, the OIG said.

DME claims rejections due to incorrect UPINs is one of the top 10 denial reasons, notes attorney Sheila Press, president of Healthcare Com-pliance Solutions in Scottsdale, AZ. If edits don't pick up outdated surrogate UPINs, a post-payment or overpayment reviewer can identify routine use of incorrect UPINs. "It might appear to be an abusive if not fraudulent billing practice," Press warns.

Kickbacks 

DME companies Pride Mobility Corp. and Performance Plus Inc. both forked over tens of thousands of dollars to settle kickback allegations, the report says. Pennsylvania-based Pride paid $80,000 to resolve charges that in its marketing program, the company "solicited and received monthly payments from suppliers in return for referring sales leads to those suppliers."

Performance paid $50,000 to settle allegations that it gave free devices to physicians who prescribed and ordered DME from the New Jersey-based company.

Hospital Beds

Suppliers are overusing an all-inclusive procedure code for furnishing a semi-electric hospital bed, a mattress and bedside rails together, the OIG insists. Using alternative coding could result in annual reduced payments to suppliers of $34 million from Medicare and $9 million from beneficiaries, Medicaid and other insurers.

The OIG wants CMS to discontinue the code or use its inherent reasonableness authority to cut payment rates for the code.

Settlements

The OIG also lists other examples where DME companies had to pay hundreds of thousands to settle charges that they billed for equipment and services when they weren't actually furnished, a physician signed blank certificates of medical necessity, and a DME company owner formed a new company under his daughter's name to avoid assessed overpayments.

"The CMN issue appears prominently" in the OIG's compliance guidance for DME, Press notes. Suppliers should consult the document to make sure they're staying within the rules.

Editor's Note: The OIG guidelines are at http://oig.hhs.gov/fraud/complianceguidance.html.