Accreditation involves unannounced inspections for two days, where surveyors accompany respiratory therapists from the companies to see how patients are set up, and perform audits on their charts to make sure the therapist is performing proper maintenance as required. The surveyors also check inventory and logs for oxygen. "That is what Medicare has used to ensure businesses are following guidelines. The stories about companies being run out of P.O. Boxes or mail drops are long over. The industry has actually been advocating for mandatory accreditation for many years but Medicare delayed this measure." Accreditation and the surety bond are the real anti-fraud measures, Brant emphasizes. "There is nothing in the DMEPOS program that really has any measures to address fraud and would have no real effect on fraud. The anti-fraud measure spoken of is really about limiting the number of providers with a real effect of just saving Medicare costs." In other words, reducing the number of providers will mean a reduction in the number of fraudulent providers.

Other effective oversight, which AMEPA supports, is a change from billing electronically with payment 30 days later to a prepay review, where CMS wants to see actual medical records, not a form that a doctor signed. "They want to see the doctor's actual notes that the patient needs a wheelchair, or that oximetry tests [are performed] for patients that need oxygen. So they have real anti-fraud and waste measures. But these are not connected to the DMEPOS bidding."


One of the more urgent problems with the bidding leading to a reduction in providers is a reduction in patient services. Brant points out that with the reduction in services, CMS may be saving money on the Part B side, but with the cutback in services, if a patient ends up in the hospital and can't be discharged, the costs are just going to be shifted to Part A, the hospital side of Medicare. "When providers are reduced, you have a patient access issue and a community resource issue. Especially in areas where there are often weather emergencies such as hurricanes or ice storms. The number of providers should not be reduced to where there are whole counties without a single provider. There are situations, such as in Dallas, where four counties do not have a single oxygen or respiratory device provider," Brant says.

Back to HCB News

More Industry Headlines