Mobility Today: Getting Serious About Accreditation
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WASHINGTON, July 19, 2007— The Centers for Medicare & Medicaid Services (CMS) appears to be getting serious about fighting Medicare fraud associated with the power mobility benefit. The agency has recently shifted their focus from measures that restrict access to power wheelchairs and scooters to actually tracking down fraudulent suppliers and putting an end to costly scams that are costing the government millions of dollars.
The power mobility industry applauds this new direction. Suppliers, manufacturers and Medicare beneficiaries still suffer from the series of regulatory changes — reimbursement cuts, new coding, competitive bidding and others — that were touted by CMS as tough action against fraud. But in most instances, the victims of these policies were legitimate suppliers and beneficiaries, not the scammers.
Clearly, the new approach may help the government curtail the fraudulent behavior that has plagued the Medicare system for years. Scam artists have connived ways to collect Medicare reimbursement payments as if they were legitimate power wheelchair and scooter providers, and that must come to a stop.
At least now, CMS has its sights on the right target: the fraudulent dealers. The agency has launched a two year demonstration project aimed at combating fraud and abuse in South Florida and Los Angeles among durable medical equipment (DME) suppliers, including power wheelchairs and scooters.
Under the initiative, suppliers (about 2,700 in South Florida and 5,000 in LA) must reapply for their National Supplier Clearinghouse (NSC) supplier numbers; these numbers are required to bill the Medicare system. In coming months, these suppliers will receive an NSC letter giving them a 30-day window to resubmit the paperwork necessary to receive and maintain an active Medicare supplier number. Suppliers who do not resubmit a form will have their supplier number revoked. In addition, the Administration is asking for a $1.3 billion dollar budget increase to fight Medicare fraud.
This is attacking the problem at the source! Without authorized supplier numbers, it will be difficult for scammers to bilk the government.
In addition to the reenrollment of suppliers in these areas, CMS will also conduct unannounced site visits. The agency will be shifting its resources to allocate additional investigators and support staff to implement the new initiative. The demonstration project is designed to engage a more proactive approach to preventing fraudulent providers from participating in the Medicare program. If the program reduces fraud and abuse in these two locations, CMS will expand the program to other parts of the country.
While this program should indeed help to reduce fraud and abuse, there are ways that CMS could make it even more effective.
The agency has publicly announced that its crackdown will unfold over a 30 to 90 day period in Los Angeles and South Florida, but will that give scam artists a window to accelerate billing on the supplier numbers that they already have? Moreover, will it also give them time to relocate their activities in areas that are NOT part of the demonstration project? The program would be more effective if it was enacted immediately — without giving the scam artists time to adjust. For instance, CMS should consider making immediate site visits, and taking the more aggressive step of canceling supplier numbers suspected of being associated with shaky suppliers. Those businesses should be forced to prove that they are legitimate.
The SCOOTER Store, which is the largest supplier of power wheelchairs and scooters in the nation, has strongly advocated for years that mandatory accreditation for all suppliers would curtail fraud and abuse. Their own reviews, which are not nearly as sophisticated as the government investigations, have nonetheless uncovered companies billing the Medicare system for power mobility equipment while operating from addresses that were dry cleaners, storefronts or vacant buildings.
In many cases, senior citizens and people living with disabilities have been victims of these scams because they never received the products or services.
To be sure, if the fight against fraud and abuse is to be successful, the government must revise the system so that scam artists no longer have easy access to NSC billing numbers that open the door to Medicare reimbursements. CMS is now requiring accreditation in connection with the competitive bidding, but that process is being rolled out slowly across the country and will take years to be fully implemented.
What's needed is mandatory accreditation for all suppliers before they can bill the Medicare system. This would force all suppliers to face a level of scrutiny that would weed out many of the fraudulent dealers and save the government millions. Another benefit is that it would improve the credibility of the power wheelchair industry, and help ensure that Medicare beneficiaries receive quality service, as well as quality products.
Mobility Today is published periodically by The SCOOTER Store to inform Congress, policymakers and the media about the latest developments regarding the Medicare power mobility benefit. We are committed to helping seniors and people living with disabilities regain their freedom and independence with power mobility equipment. The SCOOTER Store is the largest supplier of power wheelchairs and scooters in America. For more information, please contact Mark B. Leita (830) 627-4717.
