Home Health & Hospice Week

Changes shut out unscrupulous suppliers.

The Centers for Medicare & Medicaid Services should consider proposed quality standards for durable medical equipment suppliers to be minimum requirements--and the agency should toughen up the standards before publishing the final version.

So urges the New Braunfels, TX-based The Scooter Store in comments it recently submitted to the agency. The deadline for submitting feedback on the proposed standards, which CMS developed with Abt Associates of Cambridge, MA, was Nov. 28.

"Unfortunately, the integrity of dedicated power mobility suppliers has been under attack for several years because of fraud and abuse perpetrated by a few crooks posing as honest DME suppliers," says The Scooter Store President Mike Pfister. "A new level of standards should give the government confidence that the power mobility benefit will be reliably provided to needy and qualified beneficiaries."

The Scooter Store is currently embroiled in a civil countersuit filed by the Department of Justice that accuses the company of submitting fraudulent Medicare and Medicaid claims. The countersuit came after the company sued the federal government over what it says were improper claims denials.


The Scooter Store called on CMS to require mandatory third-party accreditation for all DME suppliers in the Medicare program by April 2006. It also offered recommendations for additional steps CMS could take to discourage unscrupulous suppliers.

The recommendations include having suppliers service items they sell as well as rent, bonding employees who come into direct contact with Medicare beneficiaries, and maintaining a minimum of $1 million in comprehensive liability insurance as opposed to the current $300,000 requirement.

Supplier Size Matters, PMC Notes

The Power Mobility Coalition also submitted comments on the proposed standards. The trade group called on CMS to impose the standards all at once rather than phasing them in, accepting accreditation of suppliers who have already earned it, giving special consideration to small suppliers to ensure they can meet the competitive bidding requirements, and eliminating the existing 21 supplier standards once the new standards take effect.

PMC also urged CMS to ensure administrative standards are flexible and appropriate for the supplier's size. It advised against requiring suppliers who use the cash method of accounting to adhere to the more complex and documentation-intensive Generally Accepted Accounting Principles. Furthermore, suppliers should not be required to notify CMS and accreditation agencies when they first become aware of potentially adverse financial conditions, as proposed.

"Many times, CMS contractors deny appropriate claims, levying large overpayments notices to suppliers, impacting the supplier's ability to secure financing," write PMC Executive Director Eric Sokol and PMC Counsel Stephen Azia. "Yet, historically a majority of these denied claims are overturned at the [administrative law judge] level."

Another group submitting comments was the Restore Access to Mobility Partnership, a coalition made up of the American Association for Homecare along with DME suppliers Invacare Corp., Mobility Products Unlimited, Pride Mobility Products Corp., Sunrise Medical and The MED Group.

While expressing general support for the standards, RAMP noted that preparing for accreditation is an intensive process that will disproportionately impact small suppliers. It also complained that the draft standards reflect an "encyclopedic approach" to standards that when taken together will require a level of documentation that may be overwhelming.

"Consequently, where possible, CMS should reduce the number of standards and make them more general," RAMP urges.

The group also notes that the standards will significantly increase the cost of doing business with Medicare at a time when CMS is seeking ways to reduce its reimbursement rates for DME products.