AAHomecare to Senate: Fraud Prevention Efforts Need Improvement

In a July letter to congressmen Max Baucus and Orrin Hatch, chairman and ranking member of the Senate Finance Committee, the American Association for Homecare (AAHomecare) stressed the need for tools to combat fraud and abuse in the Medicare and Medicaid programs. The letter points to the current system, which it says creates waste when resources could be better aimed at true criminal activity, and that durable medical equipment (DME) providers bear a disproportionate burden. 

“CMS’ current anti-fraud strategy employs auditors targeting conscientious providers who are having to refund millions of dollars to Medicare for failing to satisfy confusing, ambiguous, retroactive and subjective documentation requirements for items and services furnished to Medicare beneficiaries,” the letter states. 

AAHomecare, which represents DME providers, says its membership is adversely impacted by the system. 

“Because of the unique nature of billing for items on a recurring basis, DME providers are subject to audits more frequently than other types of providers,” the association writes. 

AAHomecare proposes several recommendations to Congress that would aim to improve the system. Among them, conducting independent reviews of Medicare contractors to hold them accountable; requiring that electronic health records systems include elements for DME medical necessity documentation; enhancing review of DME providers who do not respond to audit requests; and others. 

See the letter and full list of recommendations. 

Written by Elizabeth Ecker