HME News reports that Senator Ron Wyden "blindsided" the industry by sending a letter to CMS that asks the agency to (temporarily) stop issuing supplier numbers to control fraud and abuse.
Interesting.
Expect the best, plan for the worst, and prepare to be surprised. (Denis Waitley)
The industry's response is typical; everyone's against it. The funny thing is that over the years, I've heard many people in the industry say that supplier numbers are too easy to obtain and that CMS should either stop issuing them or make them far harder to get.
Maybe it's okay for people in the industry to say it, but not okay for someone else who might be in a position to make it happen? Isn't that a bit hypocritical?
The article also charges CMS with incompetence because it can't control fraud and abuse.
Interesting.
That's like saying the police are incompetent because they can't prevent crime. No agency can predict intent. Even with accreditation requirements and surety bonds and supplier standards, CMS can't know that someone is intending to commit fraud. Does that make the agency incompetent? No.
It's irresponsible to make such a charge; it smacks of passing the buck. The people who are ultimately responsible for fraud are the ones who deliberately engage in it. You disagree?
Is the victim of a robbery responsible because he has nice things? Of course not. That would be a ridiculous stand to take. But that appears to be the stand the industry is taking where CMS and the Medicare program is concerned.
The victims of the crime of fraud are the Medicare program and the tax-payers.
Cara Bachenheimer misses the point. She's quoted as saying in the article that "It's ridiculous. CMS has accreditation, and they are supposed to be going out and physically inspecting providers. Has CMS somehow said they are incapable of doing that? Because that is what the message is."
Unless Bachenheimer knows something that's not stated in the article, I don't see where a letter sent to CMS by a Senator sends a message that CMS has "somehow said" that they are incapable of doing "that" (whatever "that" is).
CMS didn't write that letter, folks. Though CMS is often the bad guy, let's blast the right party here, shall we? Let's not invent a "message" that doesn't exist.
Wayne Stanfield views the Senator's letter as "another example of being out of touch with Medicare and the whole DME benefit." Based on some of the letter's contents, that's a statement I can get behind, but only if he's talking about Senator Wyden and not CMS.
Things have changed since the 2007 OIG study that Wyden cites. AAHomecare's Walt Gorski is as guilty as Bachenheimer at missing the point, but he veers off in another direction: he splits hairs.
What's more, the letter includes a number of misleading statements. For example, Wyden states that nearly 100,000 HME providers now participate in the Medicare program. While Medicare recognizes that [there are] many active DMEPOS supplier numbers, only about 20,000 belong to HME providers. The rest belong to pharmacies, O&P companies and other kinds of providers, Gorski said.
Interesting. Here's the thing, Walt: Wyden's letter can say that there are one million HME providers participating in the Medicare program. If CMS knows better and acknowledges that, then what Wyden says can really do very little harm (if it can do any at all). Instead of nit-picking, AAHomecare, find a solution to the problems the industry is facing.
Oh, wait. AAHomecare can't; their bright idea is to ask for a round-one delay so the program can be tweaked enough to be successful. AAHomecare is the organization that's implied (if not said) that if that's done, the industry will accept competitive bidding.
There's probably a reason, AAHomecare, that you've had no luck in trying to contact Wyden to "discuss" the letter he wrote; it's because you have no influence and no credibility. You hold no cards.
Credibility is like virginity. Once you lose it, you can never get it back. (Anonymous)
At the end of the day, Walt Gorski, while CMS is trying to police a huge program, the suppliers currently in the system and those who want to join in the fun need to have more honest and more ethical intentions.
I want to see the critics of CMS do a better job at policing 20,000+ providers. It's all too easy to criticize what others do, even if you can't do the job yourself.
I know that I'm taking what will be an unpopular stand. I can live with that. For many years this industry has played the blame game, shoving all responsibility for fraud and abuse onto CMS, rather than ourselves. Oh sure, we acknowledge that there's been fraud, and we now pretend that, because of the new requirements, fraud is all but gone, and it's up to CMS to make the tiny bit left a thing of the past.
Fraud still exists. If anyone thought that supplier standards, surety bonds, and mandatory accreditation were going to cure fraud, then I've got a bridge to sell you.
A man is his own easiest dupe, for what he wishes to be true he generally believes to be true. (Demosthenes)
Credulity is belief in slight evidence, with no evidence, or against evidence. (Tryon Edwards)
fraud (frôd)
n.
1. A deception deliberately practiced in order to secure unfair or unlawful gain.
2. A piece of trickery; a trick.
3.
a. One that defrauds; a cheat.
b. One who assumes a false pose; an impostor.
The cure for fraud is simple. It's so simple, in fact, that it's almost silly. The cure for fraud is honesty. It's not the responsibility of CMS to "make" you honest; that's far beyond the agency's reach. The responsibility for honesty lies with every individual participating in the system.
Fraud is the ready minister of injustice. (Edmund Burke)
If there is injustice in the current system (and there is!) toward the providers who are honest and ethical, CMS is not to blame. And shame on anyone who says that the system "invited" fraud. It's a sad state of affairs when the people who are committing fraud aren't strung up; it does no credit to any honest person when he or she blames the system for being robbed.
It is easy to dodge our responsibilities, but we cannot dodge the consequences of dodging our responsibilities. (Josiah Charles Stamp)
When government accepts responsibility for people, then people no longer take responsibility for themselves. (George Pataki)
Has the agency done a good job dealing with the problem? I think they've been slow and heavy-handed. But most large government agencies are. Name one that's nimble. Go ahead, I'll wait right here.
I know that a very large portion of providers participating in the Medicare program today have never deliberately cheated the system. Yes, there have been billing errors that may have resulted in over-payments from Medicare, but things happen.
I also know that there are many out there participating in the Medicare program today who have knowingly and deliberately billed for items that their patients didn't need and never got (and for repairs not needed nor performed). I know that there are many out there participating in the Medicare program who have "padded" what they submit for reimbursement; an extra few dollars here and there that no one will miss, right?
Wrong. An extra few dollars here and there add up to millions in no time flat. Add that to the companies formed for the purpose of committing fraud, and the Medicare program bleeds money at an alarming rate.
I've complained along with most of the rest of you that CMS takes too long to catch someone who's committing fraud. Does an investigation really need to take a few years? Some seem to drag on forever! The thing is, though, that if due process isn't followed, the agency will be accused of railroading "innocent" providers; it's really a no-win situation if you think about it objectively.
Competitive bidding is a reaction (an extreme reaction) to providers choosing to rob the Medicare program. But it wouldn't have come about if the program hadn't been abused. The bid is going to eliminate suppliers. Thousands will end up closing their doors. When competitive bidding fails, the industry needs to have a viable plan ready to replace it. It isn't enough to tell legislators and CMS what we don't like, what we don't want, what isn't fair, and that the agency isn't doing enough. We need a Plan B that will render suggestions like the one Senator Wyden made pointless.
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