Home Health & Hospice Week

One Medicare contractor is taking on fraud in the home care arena with a new plan, but the pilot project could produce more hassles than benefits.

Medicare Administrative Contractor National Government Services is initiating the "DMEPOS Card Swipe Pilot Program" in the Indianapolis area, it announces on its website. The pilot asks both physicians and durable medical equipment suppliers to voluntarily participate.

How it works: When a physician orders DME for a patient, he will swipe a specially provided card in his already existing credit card terminal and enter the patient's HICN. Then when a supplier furnishes the DME, it will swipe its own card and enter the patient's HICN. NGS then will match up the transactions to determine whether the DME was ordered by a legitimate physician and furnished by a legit supplier, NGS says on its site. "By verifying that a legitimate physician wrote an order for DME and that it was dispensed by a legitimate supplier, certain types of fraud and abuse can be eliminated from the program," the MAC explains.

The problem is that this project may end up being burdensome to suppliers without producing any real fraud-fighting benefits, worries Washington, D.C.-based health care attorney Elizabeth Hogue. For example, if the card NGS issues to you doesn't work, you have to call for customer support.

This could be "a prescription for disaster," Hogue predicts. Potential problems could include "long periods of time on hold [and] representatives who don't have any idea what suppliers are talking about," for example.

"Looks to me like it's something else for suppliers to do with very little clear benefit to anyone," Hogue tells Eli.

The program does allow for a more "realtime match up of the order and the delivery of equipment," observes attorney Robert Markette Jr. with Benesch/Dann Pecar in Indianapolis. But "fraudulent providers would simply swipe the cards in much the same way they currently submit fraudulent signatures," Markette expects.

If NGS and Medicare do find the program helpful in cutting down on fraud and abuse, home care providers may expect to see it enter their market. That's because home care providers are also deemed a provider type at high risk for fraud by the HHS Office of Inspector General and the Centers for Medicare & Medicaid Services.

For HHAs, contractors could even go so far as to give beneficiaries a card, with patients having to swipe for each visit, Markette suggests. That "would allow confirmation of each visit. That would at least make it harder to commit home health fraud, because you would need to obtain a beneficiary's card on each visit."

But it would also be "a major pain" for HHAs logistically, Markette allows.

The project also may not achieve much in HHAs, because their fraud risks are different than those of DME providers, notes attorney Joel Hamme with Powers Pyles Sutter & Verville in Washington, D.C. "The fraud and abuse problem in DME relates to things like supplier enrollment, dummy companies, billing without orders, duplicate billing, etc.," Hamme points out. "Although there may be some of that in the home health area, I think the major problem, instead, involves medical necessity and overutilization of services."

In or out: For the current card swipe pilot and any future, similar voluntary projects, providers have to decide whether to participate. Each provider "would have to evaluate the relative benefits and costs to determine whether it makes sense for their agency or program," advises attorney Marie Berliner with Lambeth & Berliner in Austin, Texas.

Providers in the pilot area shouldn't give in to pressure to participate if it is harmful to their organization. Instead, if a provider "decides, after considering the pilot program, that it is not right for their business for any reason, they could still learn new ways to prevent and address fraud on their own," Berliner suggests.