Home Health & Hospice Week

DME is in the spotlight again.

The feds are stepping up efforts to crack down on Medicare fraud and abuse involving home medical equipment--and not a moment too soon for industry trade groups and federal watchdogs.

The U.S. Department of Health and Human Services announced May 9 that the first phase of a new targeted criminal, civil and administrative effort against fraud had led to 38 arrests in southern Florida. The so-called "strike force" is targeting suppliers of durable medical equipment and infusion therapy.

The news comes on the heels of a report from the Government Accountability Office suggesting that the Centers for Medicare & Medicaid Services failed to implement automated controls to flag unusual charges, a shortcoming that opened the floodgates for fraud.

For example, Medicare paid more than $2 million for braces for patients whose earlier amputations negated the need for the devices, the GAO said.

Too little, too late: Soon after HHS announced the arrests, the American Association for Homecare issued a statement praising the strike force that netted the arrests in Florida, but taking CMS to task for failing so far "to effectively exercise its already ample authority to combat fraud and abuse."

"Accreditation and tightened restrictions on entities that are allowed to obtain billing privileges will go a long way toward establishing an environment where unscrupulous companies cannot operate," AAHomecare's Tyler Wilson said in a statement.

Early success: Since the first phase of strike force operations began on March 1, the feds have obtained indictments of individuals and organizations that have collectively billed the Medicare program for more than $142 million, reports HHS.

Charges brought against the defendants in these indictments include conspiracy to defraud the Medicare program, criminal false claims, and violations of the anti-kickback statutes. • Your patients' outcomes won't be the only official indicators of your care quality much longer, if new patient quality measures materialize as the feds wish.

CMS has process-based quality measures on deck, the agency says in the prospective payment system refinements proposed rule issued April 27. The agency would like to propose next year some "patient-level process measures" as part of the home health quality improvement program, according to the proposed rule. CMS hopes to implement such measures by 2010.

The agency also continues to develop a patient satisfaction survey as part of the HHQI initiative.

CMS will work with the Agency for Healthcare Research and Quality (AHRQ) to field test the Home Health Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey later this year, the rule says. • If you're frustrated by Medicare enrollment delays, they may be your own fault, according to a report from the HHS Office of Inspector General.

There were two reasons for long delays in processing enrollment applications after [...]