Home Health & Hospice Week

There's good news if you're reactivating your number.

Operation Wheeler Dealer's watch on power wheelchair fraud has let up enough to allow a few supplier numbers to squeak through.

The Centers for Medicare & Medicaid Services announced last month that the supplier number application process would be frozen while CMS and the National Supplier Clearinghouse scrutinized applications for potential power wheelchair and scooter fraud (see pdf of Eli's HCW, Vol. XII, No. 32, p. 251).

But now durable medical equipment regional carrier Palmetto GBA says certain providers are exempt from the moratorium. "This hold no longer applies to reactivations," Palmetto says in an Oct. 1 email update. "(CMS) has approved processing reactivations."

Suppliers seeking reactivations might not be the only folks who see a reprieve from the fraud and abuse-related measure. CMS is developing "a profile of supplier applications that can be expedited," says the American Association for Homecare. "Chain operations" might be the next providers deemed to pose little or no risk to the Medicare program for wheelchair fraud, and thus allowed to have their applications process, AAH says.

For now, CMS plans to continue heavily scrutinizing applications of suppliers that have little to no history with Medicare, AAH notes.

"The NSC will be processing applications as far as possible and then placing them on hold until further word comes from CMS," Palmetto says on its Web site.

The supplier number halt applies to applications from all suppliers, not just those who furnish wheelchairs, the DMERC notes. It affects new applications as well as ones already in process when CMS and the HHS Office of Inspector General announced Operation Wheeler Dealer.

The announcement comes after complaints from the industry that the unanticipated supplier number moratorium would harm innocent DME bystanders. In a Sept. 11 Open Door Forum on the issue, participants warned that the hold would place a heavy burden on companies making acquisitions and trying to maintain services.

Health care attorney Elizabeth Hogue says one of her DME clients had a near miss with disaster due to the freeze. The company was told its supplier number would be held up due to an administrative error - the supplier's liability insurance expired during the applications process, and rather than ask for a copy of the renewed policy, the NSC denied the application.

After the wheelchair-related freeze was announced, the NSC told the supplier it couldn't reinstate the number until the hold was over, Hogue reports. "We're talking about people going out of business," Hogue says. "It's looking like a bloodbath."

Now that CMS has decided the hold doesn't apply to reactivations, her client's hold-up has been eliminated, Hogue reports. But the same probably isn't true for many other suppliers, she predicts.

"If you are able to demonstrate that the supplier met all of the requirements, the number may be reactivated," she explains. "The problem is that ... there is a great deal of confusion."

If suppliers encountered a problem and had their applications denied, they need to show exactly what happened during the renewal process and how they really do meet the standards. "Unless suppliers have very excellent documentation about what happened when, they may still have a problem," she warns.

Suppliers should carefully document extensions for renewal applications, Hogue adds.