Home Health & Hospice Week

Federal watchdog wants CMS to go further in protecting Medicare enrollment.

Once again, legitimate suppliers are getting a bad rap thanks to fraudsters.

Compliance problems persist with Los Angeles County durable medical equipment suppliers, according to a new report from the HHS Office of Inspector General. The OIG inspected 905 suppliers on four "easily observed rules requiring that each supplier: (1) maintain a physical facility, (2) be accessible during reasonable business hours, (3) have a visible sign, and (4) post hours of operation," the watchdog agency says.

The OIG found that 115 suppliers (13 percent) did not maintain a physical facility or were not open during unannounced site visits. "Another 79 suppliers (9 percent) were open but did not meet at least one of the two additional requirements for the standards we reviewed," the OIG says in a release. Those included posting business hours and business names. An additional 124 suppliers (14 percent) had other irregularities.

CMS is already conducting a fraud-fighting demonstration project focusing on enrollment in the LA area, the OIG acknowledged. But the report offers more suggestions for tightening up the enrollment process, including conducting more unannounced site visits and running more rigorous background checks.

The report is online at http://oig.hhs.gov/oei/reports/oei-09-07-00550.pdf. • Regional home health intermediary Cahaba GBA is telling providers to put their Medicare legacy numbers back on their claims in some situations. CMS is urging providers to start testing National Provider Identifier-only claims in advance of the May 27 deadline for NPI-only claims.

But providers will see claims returned with reason code 32000 if the claims system can't figure out what kind of claim it is based on the NPI. This happens if a provider has an NPI that applies to subunits that are different provider types, Cahaba explains in a message to providers.

"To correct claims in RTP with reason code 32000, enter your Medicare provider (Oscar/legacy) number in the 'Oscar' field on the FISS Claim Page 01," Cahaba instructs. "To avoid claims from going to RTP with reason code 32000, report the Oscar/ legacy number when you initially submit your claim." Providers may have to acquire an NPI for each subunit to avoid this problem, the intermediary suggests.

NPI information is at www.cms.hhs.gov/NationalProvIdentStand. • Your local Medicare contractor could soon adopt fraud-fighting practices from other contractors around the country. Infusion therapy fraud in South Florida has encouraged intermediaries and carriers to work together on fraud schemes that spread from one region to another, CMS notes in March 7 Transmittal No. 326 (CR 5725).

In the infusion fraud case, the Florida carrier first developed a series of edits to flag suspicious claims, CMS explains. Then data suggested the fraud was moving to Michigan, New York and New Jersey. Each [...]