Home Health & Hospice Week

Failing to use manufacturer discounts a pricey mistake for one New York supplier. Medicaid enforcement is hotter than ever in the durable medical equipment arena. A DME supplier that failed to take advantage of manufacturer discounts has a big debt to pay to the New York Medicaid program. According to New York Attorney General Eliot Spitzer, Rochester, NY-based Monroe Wheelchair Inc. has agreed to pay $400,000 to resolve alleged Medicaid overpayments. A Medicaid fraud control unit audit revealed that Monroe - formerly known as Patient Services and Supply Inc. - failed to take advantage of manufacturer discounts between 1995 and 1999, according to Spitzer. That lapse resulted in overpayments for hundreds of wheelchairs because New York's Medicaid program reimburses DME at the "acquisition cost" plus 50 percent. The acquisition cost is defined as the lowest price offered to the general public, including discounts and rebates. Since Monroe didn't secure the lowest price available, amounts billed in excess of that amount were considered overpayments. "Once the error was brought to the attention of the provider, they agreed to reimburse the state," Spitzer points out. In addition to the monetary settlement, Monroe agreed to establish a three-year compliance initiative that will include three hours of training per year to managers, sales personnel and employees involved in claims submissions.