What do these words have in common? They describe the current administration of the Medicare system. For years our business has been regulated by Medicare and certain State / Local regulations which include unannounced visits to be sure we are what we say we are. Oh yes, these inspectors take pictures of the storefront, hours we are open, signage and how much inventory we have in the store & warehouse. When I started there were 12 supplier standards we now have 30, mandatory accreditation (every 3 yrs. at a cost of $ 6000 to $ 8000) and a surety bond. Yes, insurance protection in case we fly the coop and or can’t pay back money that was erroneously billed. There are now contractors hired to audit suppliers on previously filed claims to be sure everything was filed & documented. Even providers with perfect documentation must still go through the audit process, which is time consuming and freeze potentially funding until complete. These companies are paid a percent on what is recovered. Can you visualize the paper trail that is required (10 years we are required to store patient records) takes time and space? Have you got the picture? Fear – Intimidation – Watchdogs for Taxpayers – Over burdensome Bureaucrats – Bullies of small business owners.
I have not mentioned the “ Competitive Bidding “ fiasco that will reduce the number of suppliers in this market and if implemented 1/1/2011 will further show the lack of concern CMS has for it’s beneficiaries. Patients will have fewer choices with more people being hospitalized and more cost in the long run. Any policy that eliminates equipment providers, that make home – based care possible is headed in the wrong direction and needs to be repealed. The 2010 mid term elections are where we can make our voice heard! If you want more information, email me at tom@specialtymedical.com
We have been in business 22 years because we take care of patients who become customers and many are now friends who rely on our staff for help. Our staff has grown to six with 49 years of combined experience in handling almost every issue of service, claims, insurance and communicating the nuances of this complex system to our customers.
We are not dependent on Medicare revenue to survive; this is by design as diversification is crucial in any business and personal finance. My point iswe play by the rules and it has become too burdensome. I see the double standard that exists with the“ to big to fail “ mentality of the Government. Wall Street, Bankers, AIG, GM get bailed out while the real economy of this country soldiers on. Small businesses in our Industry will go out of business but it should not be because of CMS and their poor policies, punitive attitude of indifference and gross incompetence.
Example:
CMS’ Inability to Curb Fraud
Senate Finance Ranking Member Charles Grassley (R-Iowa) has raised concern about CMS’ apparent inability to curb fraud. In a recent letter to CMS Administrator Donald Berwick and HHS Secretary Kathleen Sebelilus, Grassley reiterated his concerns about the “lack of or management and oversight of contractors by the Centers for Medicare and Medicaid Services (CMS)” to curb fraud, waste, and abuse.
Referring to the U.S. government-filed complaint against All-Med Billing Corp. in 2004, the senator states, “MAC’s responsibilities include adjudicating and processing claims, yet it appears from this case that Palmetto GBA allowed millions to be paid to the DME companies for fraudulent claims.
According to the complaint, All-Med had submitted $250 million in Medicare claims to the Medicare Administrative Contractor, Palmetto Governmental Benefits Administrator (Palmetto GBA) from Jan. 2004 to June 2004 for medical equipment that had neither been ordered by a physician nor delivered to the beneficiary. It was not until Feb. 2010 that a judgment against All-Med was entered, requiring more than $445 million repayment to the U.S. government.
As Grassley expresses his concern about CMS’ incompetence, the media continues to report of Medicare fraud. Meanwhile, CMS continues to chase small providers with bogus audits as millions of dollars are being paid to bogus clinic addresses. This was reported the week of Oct. 11 in the Dallas Morning News and I have copied the following content:
“A recent New York Times City Room Blog reported that 44 individuals are being charged for Medicare fraud. An Armenian-American crime syndicate operated the “largest Medicare fraud operation ever carried out by a single group.” The crime group had 118 phantom clinics and stole the identities of both doctors and patients to bill Medicare $100 million in nonexistent treatments. The group, official said, was aware that each clinic had a limited shelf life and would simply turn to another fraudulent clinic — they existed only on paper with an address that was usually a mail drop — operating at least 118 in 25 states. The group succeeded in stealing $35 million in Medicare reimbursements, officials said, before the charges were leveled and arrests were made on Wednesday.
“The diabolical beauty of the Medicare fraud scheme — from the criminals’ standpoint — was that it was completely notional,” Ms. Fedarcyk said in a statement released in the early afternoon. “There were no real medical clinics behind the fraudulent billings, just stolen doctors’ identities. There were no runners or colluding patients showing up at clinics for unneeded or “upcoded” treatments, just stolen patient identities. The whole doctor-patient interaction was a mirage.”
While the CMS noted in a release that it would “identify and shut down the bogus clinics after several months,” the agency had already paid millions of dollars to the phantom clinics, according to the blog.
How nice of CMS to waste our tax dollars and yet they know were our business is located but can’t locate and follow their own protocol on approving new companies that want to bill Medicare. This scenario is consistent with CMS and their poor business practices.
My advice is leave our industry alone, we are 1.3% of the Medicare budget, establish a fair fee for products & services and enforce the same standards on every medical provider. Every clinic can be physical checked by the same contractors who visit us to take pictures before assigning a Medicare provider number. If you did thisyou would have found the PO Boxes that served as a clinic and saved taxpayers $ 35 million.
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