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Headline News
New Version of Bill to Ease NCB Expected This Week
WASHINGTON--Athough CMS has yet to issue its final rule on national competitive bidding, the industry is moving ahead with renewed plans to ease its effects.

Last year Reps. David Hobson, R-Ohio, and John Tanner, D-Tenn., introduced a bill that would have softened several provisions of the Medicare Modernization Act's DME competitive bidding mandate. While H.R. 3559, which came to be known as the Hobson-Tanner bill, picked up 151 cosponsors in the House and a companion bill in the Senate, Congress adjourned with no action on the proposed legislation.

But according to some in Washington, many of those cosponsors are ready to sign on again to a new version of the bill, which could be introduced as soon as this week.

With more than 130 cosponsors of H.R. 3559 who returned to office, "we believe that there already is a base of strong support," said Walt Gorski, vice president of government relations for the American Association for Homecare.

While efforts to repeal competitive bidding continue, he added, "based on the political environment here in Washington, if repeal is not achievable, efforts must be made to modify competitive bidding so that it does not adversely impact beneficiaries and suppliers."

Much of the new bill, this time around with Tanner as the lead, will mirror H.R. 3559, but there are some changes, Gorski said. The new proposal would allow any willing provider--that is, any qualified home care company that submitted a bid below the current allowable--to continue to supply equipment under Medicare at the bid rate that is set. A similar exemption in H.R. 3559 would have applied only to small providers, then defined as those with revenues under $6 million.

Under MMA, bidding must start in 10 of the country's largest MSAs (also yet to be announced) in 2007, then expand to encompass 80 areas in 2009.

Gorski said another new provision of this year's bill would require Medicare to conduct an impact analysis on beneficiary access to quality products and services after competitive bidding has been fully implemented in the first 10 cities. The bill also would prohibit HHS from expanding the bid program to additional MSAs, or applying bid rates to non-bid areas, unless specifically authorized by Congress.

As far as passage of the new bill this year, "I really think our chances are good," said Seth Johnson, chairman of AAHomecare's Rehab and Assistive Technology Council and director of government affairs for Pride Mobility. However, he cautioned, it's still early in the congressional session and lawmakers "haven't started having specific hearings on developing Medicare legislation yet.

"The main thing we need to do in order to ensure success this time is to get the cosponsors that are still in office to sign on to the bill again, and then we need another 80 or so [representatives] to support it," Johnson said.

Johnson said Sen. Orrin Hatch, R-Utah, who introduced the Senate companion to H.R. 3559 last session, is expected to champion the measure again in that chamber with Sen. Kent Conrad, D-N.D.

The report also said the FBI had identified organized criminal activity in a variety of health care sectors, including durable medical equipment companies.

AAHomecare: Zero Tolerance for Fraud and Abuse
WASHINGTON--On Thursday, members of the House Ways and Means Health and Oversight subcommittee convened a Medicare program integrity hearing to ask law enforcement officials what tools they needed to ramp up the fight against fraud and abuse in the system.

While some, like R. Alexander Acosta, U.S. Attorney for the Southern District of Florida, said more funding would be helpful, HHS Inspector General Daniel Levinson said the OIG was adequately funded and recovered $13 for every dollar spent.

Questions from subcommittee members also centered on whether stiffer laws were needed for criminal prosecution of suspected fraud, an idea some agreed merited further consideration.

The American Association for Homecare also weighed in with a statement, stressing "zero tolerance for Medicare fraud and abuse of any kind."

The association cautioned against "any overgeneralizations about the home care sector" and championed more effective enforcement of the safeguards against fraud and abuse that Medicare currently has in place.

The association offered several suggestions for curbing fraud and abuse:

--First, the guiding principle should be to provide Medicare beneficiaries with medical equipment technology and therapies that are medically necessary and appropriate to give the patient a fuller, more satisfying and healthier life.

--Second, Medicare coverage, coding, reimbursement and documentation policies as well as standards for quality, should be clear and unambiguous. In recent years, for instance, AAHomecare has worked with CMS and its contractors to revise coding for power wheelchair products to improve Medicare coding and coverage practices.

The Association also has embraced the federal quality standards and accreditation requirements for home medical equipment required by the Medicare Modernization Act of 2003 (MMA) and has worked closely with CMS to develop sound quality standards. In fact, last year we recommended that CMS adopt standards that were far more stringent than what the agency adopted in its final standards issued in November 2006. Many of the requirements from the MMA are only now nearing implementation.

--Third, the Medicare program has numerous anti-fraud and abuse safeguards in place that must be more effectively enforced. Currently, the Medicare program requires that suppliers adhere to 21 specific supplier standards (42 CFR 424.57) in order to obtain and maintain billing privileges.

"We believe that proper enforcement of the current 21 standards along with new quality standards and accreditation will go a long way toward cracking down on criminal activity," the association said.

Florida Attorney Pleads Guilty in DME Company Sales Scam
MIAMI--A well-known Florida attorney who specialized in sales of durable medical equipment companies pleaded guilty on Thursday to Medicare fraud conspiracy and now faces a sentence of up to 10 years in prison, according to the U.S. Attorney's Office, Southern District of Florida.

According to court documents, Benjamin R. Metsch and an unnamed co-conspirator schemed to facilitate the fraudulent sales of 67 south Florida DME companies from October 2002 through August 2004.

Authorities said that Metsch and his co-conspirator attempted to conceal the names of the true purchasers of the companies by preparing "fraudulent sales documents, including stock transfer agreements and operational agreements concerning DME companies that previously had received authorization from Medicare to bill Medicare Part B to receive reimbursement for DME-related items and services." The documents also often greatly understated the true sales prices, authorities said.

The scheme involved "straw" purchasers who, with the knowledge of Metsch and his co-conspirator, acted in the place of the true buyers. That is a violation of both federal law and Medicare rules that require "truthful, complete information concerning the ownership and control of Medicare providers, including DME companies," authorities said.

Once the sales had closed, the purchasers failed to notify Medicare of the changes in ownership in a timely fashion, the court records indicated. Under Medicare rules, DME companies have 30 days after a change or update in ownership in which to report the changes.

"This impaired Medicare's ability to properly oversee the activities of those companies," the court documents said.

The companies then submitted fraudulent Medicare claims for DME items and services as though they were still owned by the prior owners.

The scheme netted Metsch's law firm $103,000, according to authorities; in a plea agreement, Metsch has agreed to pay that amount in restitution. Metsch could get up to 10 years in prison and be fined a maximum of $250,000. He is scheduled to be sentenced on May 18.

To report suspected Medicare fraud, contact the Office of Inspector General by calling (800) HHS-TIPS; e-mailing HHSTips@oig.hhs.gov; faxing (800) 223-2164 (no more than 10 pages) or mailing Office of Inspector General, HHS TIPS Hotline, P.O. Box 23489, Washington, D.C. 20026. For more details, see "Medicare Fraud: How to Report" at www.medicare.gov/FraudAbuse/HowToReport.asp.

"Most suppliers of medical equipment like leg braces and glucose test strips are honest, but the bad actors cost the program $700 million every year."

RESNA Gears Up to Credential More Practitioners, Suppliers
ARLINGTON, Va.--With just a little over a year before implementation, the Rehabilitation Engineering & Assistive Technology Society of North America is cranking up its efforts to meet a credentialing mandate from CMS.

Beginning April 1, 2008, CMS will require that the specialty evaluation for certain power wheelchairs be performed by a RESNA-certified Assistive Technology Practitioner (ATP) specializing in wheelchairs or a physician who is board-certified in physical medicine and rehabilitation.

The agency will also require that the wheelchair come from a supplier employing a RESNA-certified Assistive Technology Supplier (ATS) "who is directly involved in the wheelchair selection for the patient."

The RESNA-certified ATP or the physician cannot have a financial connection to the supplier.

The specialty evaluation refers to patients receiving a Group 2 single- or multiple-power option power wheelchair, any Group 3 or Group 4 power wheelchair or a push-rim activated power assist device for a manual wheelchair.

"We are, as an organization, trying to prepare for the increased interest in two credentials that CMS has so far adopted--the ATP and the ATS," said Glenn Hedman, president of RESNA and director of the Assistive Technology Unit at the University of Illinois, Chicago.

A decade ago, RESNA devised the ATP credential for service providers involved in the analysis of a consumer's needs and training in the use of a particular device. The ATS is for those who are involved with the sale and service of rehab equipment, assistive technology and commercially available products or devices.

RESNA also offers a Rehabilitation Engineering Technologist credential for those "who apply engineering principles to the design, modification, customization and/or fabrication of assistive technology for persons with disabilities."

The purpose of credentialing is two-fold, according to RESNA: to ensure consumer safeguards and to ensure consumer satisfaction.

Currently, the organization has certified 2,700 people, according to Thomas Gorski, executive director. "We are geared up to increase those numbers significantly, if not double them, in short order," he said. "We have increased the number of exams in 2007, and we are seeing enlarged numbers of people seeking information about the exam."

Hedman said RESNA will offer the credentialing exam at least 25 times this year. "That's the baseline. We may offer it more. We're trying to make it available to people who are really interested."

The ATP or ATS exam, which is generally taken by those who have backgrounds as rehabilitation engineers, occupational or physical therapists, speech and hearing pathologists or suppliers, costs $500. Candidates must answer 200 questions, 150 of which are general questions about assistive technology, said Gorski, with another 50 questions specific to a supplier or a practitioner.

Meanwhile, RESNA is also exploring the possibility of creating another specialty credential, this one in seating and mobility. Hedman said RESNA has had preliminary talks with the National Registry of Rehabilitation Technology Suppliers about such a credential.

"We are interested in working with NRRTS on further demonstration of skills and expertise in the seating and mobility area," said Hedman. "I think the potential is really there to work together to identify an increased level in seating and mobility. Each of these concepts would be built upon the skills that someone has as an ATP."

Hedman said that implementation of the new credential could be "conceptually possible this year."

The seating and mobility credential would be a natural extension of the relationship between RESNA and NRRTS. The latter lists 800 registrants on its rolls; only NRRTS registrants who have passed RESNA's ATS exam can carry the Certified Rehabilitation Technology Supplier designation.

To view RESNA's exam schedule for 2007, visit www.resna.org.

The University of Pittsburgh's Department of Rehabilitation Science & Technology is planning review courses for those who wish to prepare for the ATP and ATS exams. For more details, contact Pitt faculty member Mark Schmeler at schmeler@pitt.edu, or visit www.rstce.pitt.edu.

Coming Up
CMS will hold its regularly scheduled Home Health, Hospice and DME Open Door Forum on Wednesday, March 14, at 2:00 p.m. (EDT). To participate by phone, call (800) 837-1935 and use conference ID number 9400956.

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