WASHINGTON, D.C. – Last month, news organizations published articles regarding potential Medicare fraud schemes by a handful of intermittent catheter companies that was presented to the federal government by the National Association of Accountable Care Organizations.
AAHomecare is appalled at the level of fraud that occurred from what appears to be outright criminal elements that preyed on Medicare’s vulnerabilities using the catheter benefit. In a statement shared with CMS and Capitol Hill, AAHomecare affirmed its support for the ability of the federal government to implement real-time monitoring of submitted claims to detect potentially aberrant or abusive behavior.
AAHomecare’s statement also reiterates our recommendations for federal government initiatives to better monitor DME supplier billing practices and trends, including:
- Increased monitoring and scrutiny of claims submitted by DME suppliers who are new to the Medicare program.
- Increased monitoring and scrutiny of claims submitted by DME suppliers that submit claims for new product categories.
- Close monitoring of significant increases or spikes in claims submissions for a specific product category over a short period of time.
- Supporting electronic prescribing between physicians and suppliers; would only allow legitimate and verifiable prescriptions for the benefit and safety of patients while allowing payer insight to mitigate abusive billing practices.
The statement also notes that the industry has been working in collaboration with clinical, patient and disability organizations to convince CMS to refine the HCPCS coding system for intermittent catheters. We will continue to advocate for a more nuanced HCPCS coding system for intermittent catheters that would provide program integrity benefits and remain committed to working with policy makers to reduce and eliminate fraud and abuse related to intermittent catheters and the full spectrum of DME products and services.
