/PRNewswire/ -- With the Senate approval today to extend emergency Medicaid relief (FMAP) until June 30, 2011, the American Health Care Association (AHCA) and the Alliance for Quality Nursing Home Care praised the vote and urged the House of Representatives to follow suit, saying the additional $16.1 billion in federal funding will help the nation's most vulnerable seniors retain access to quality care, while protecting key frontline health jobs.
"We applaud the Senate for taking action to pass this vital Medicaid relief, and urge the House to follow in the same manner. Every day that passes without an extension of this funding, seniors' care is placed in jeopardy, facility staffing stability is compromised, and good, local health jobs are put at risk," said Bruce Yarwood, President and CEO of AHCA. "The time to act is now. Our governors have repeatedly expressed the desperate need for relief, and we ask Congress to act on this critical health care policy matter."
"Senate passage of this legislation brings us one step closer to providing the vital funding needed to protect every senior's access to the skilled nursing and rehabilitative care they require and deserve," said Alan G. Rosenbloom, President of the Alliance. "We thank those Senators who took this stand for seniors and urge the House to follow with swift passage as well."
Yarwood and Rosenbloom pointed out that adequate Medicaid funding is directly linked with skilled nursing care and local caregiver job stability throughout America. Without the extension of emergency Medicaid relief, pressure mounts on governors to further reduce Medicaid-financed care and services.
A strong bipartisan majority of governors are adamant about the need for immediate action, as the National Governors' Association (NGA) recently noted, "Funding for FMAP is a particularly effective tool because it immediately allows Governors to eliminate planned budget cuts required to meet balanced budget requirements and continue services for those with the greatest need."
"We urge state legislatures and governors to use this increased funding to ensure our nation's seniors receive the funding necessary to provide high quality care as well as job stability for frontline caregivers," concluded Yarwood and Rosenbloom.
This measure will now return to the House of Representatives, where it could be considered as early as September when Members return from the August work period.
-----
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Showing posts with label seniors. Show all posts
Showing posts with label seniors. Show all posts
Thursday, August 5, 2010
Tuesday, June 8, 2010
HHS Secretary Kathleen Sebelius and U.S. Attorney General Eric Holder Send Letter to State Attorneys General On New Outreach and Education Efforts to Combat Medicare Fraud
U.S. Secretary of Health and Human Services Kathleen Sebelius and Attorney General of the United States Eric Holder today sent a letter to state attorneys general urging them to work with HHS and federal, state, and local law enforcement officials to mount a substantial outreach campaign to educate seniors and other Medicare beneficiaries about how to prevent scams and fraud beginning this summer. The outreach campaign is another step in the ongoing work of the Health Care Fraud Prevention Enforcement Action Team (HEAT), a cabinet-level initiative launch by HHS and DOJ in May 2009.
“We are heading into the week when our first tax-free $250 donut hole rebate checks will be mailed out to Medicare beneficiaries who have fallen into the coverage gap. Accordingly, we are especially concerned about fraud and increased activity by criminals seeking to defraud seniors – and we are seeking your help to stop it,” said Secretary Sebelius and Attorney General Holder in the letter. “Building on our record of aggressive action, we will use the new tools and resources provided by the Affordable Care Act to further crack down on fraud.”
In the letter, the Secretary and Attorney General outline education and outreach efforts where state attorneys general could make a big difference. These include efforts to cut the improper payment rate, which tracks fraud, waste and abuse in the Medicare Fee for Service program, in half by 2012; a series of regional fraud prevention summits around the country over the next few months; regular health care fraud task force meetings to facilitate the exchange of information with partners in the public and private sector, and to help coordinate anti-fraud effort; HHS’s plans to double the size of the Senior Medicare Patrol and to put more boots on the ground in the fight against Medicare fraud; and a new educational media campaign this summer to educate Medicare beneficiaries about how to protect themselves against fraud.
The full letter follows.
June 8, 2010
Dear Attorney General:
It was a pleasure to have the opportunity to speak with you and your staff a few weeks ago. We wanted to send you a letter summarizing our discussions and following up with some suggestions of ways we can work together to protect the American people from health care fraud.
In the two months since the Affordable Care Act was signed into law, we have made substantial progress on providing better choices for consumers, tackling health care costs, and holding insurance companies accountable. But while we have been hard at work, scam artists and criminals continue to profit from misinformation about the Affordable Care Act.
Since early April, we have heard increasing reports about seniors being asked to provide their Social Security numbers in order to receive a “donut hole” check under the new law, raising concerns about potential identity theft scams. We have fielded consumer complaints about phony insurance policies, and our Senior Medicare Patrols have been receiving a growing number of calls from people across the country reporting potential fraud schemes.
We are heading into the week when our first tax-free $250 donut hole rebate checks will be mailed out to Medicare beneficiaries who have fallen into the coverage gap. Accordingly, we are especially concerned about fraud and increased activity by criminals seeking to defraud seniors – and we are seeking your help to stop it.
The President has asked us to reach out to you and to other federal, state, and local law enforcement officials across the country to mount a substantial outreach campaign to educate seniors and other Medicare beneficiaries about how to prevent scams and fraud. Some important components of these outreach and education efforts, where you and your staff could make a big difference, are described below.
First, the President has directed the Department of Health and Human Services (HHS) to cut the improper payment rate, which tracks fraud, waste and abuse in the Medicare Fee for Service program, in half by 2012.
Second, following on the National Health Care Fraud Summit we co-hosted in Washington earlier this year, the President has asked both our Departments to convene a series of regional fraud prevention summits around the country over the next few months. The first summit will take place in Miami on July 16. Other summits will follow in, for example, Los Angeles, Las Vegas, Detroit, Boston, New York, and Philadelphia.
These summits will bring together top federal and state officials; representatives of federal, state, and local law enforcement; representatives of our agencies; the health care provider community, such as hospitals and doctors; local businesses; the Senior Medicare Patrol; caregivers; and seniors, for a day of panels and training sessions. Your expertise and experience will be instrumental to the success of these events.
Third, at the Attorney General’s request, the Acting Deputy Attorney General has sent a memo to every United States Attorney in the country asking them to convene regular health care fraud task force meetings to facilitate the exchange of information with partners in the public and private sector, and to help coordinate anti-fraud efforts. Most of these meetings will be held quarterly, with some exceptions for smaller districts. All 93 U.S. Attorneys have been asked to put a plan into place and schedule their first meeting by August 16, 2010. We hope that you and your office will take part in these regular exchanges on effective fraud fighting strategies.
Fourth, HHS will be doubling the size of the Senior Medicare Patrol and putting more boots on the ground in the fight against Medicare fraud. Since 1997, HHS and its Administration on Aging have funded Senior Medicare Patrol projects to recruit and train retired professionals and other senior citizens about how to recognize and report instances or patterns of health care fraud. Close to three million Medicare beneficiaries have been educated since the start of the program, and more than one million one-on-one counseling sessions have taken place with seniors or their caregivers. Currently, the Senior Medicare Patrol program funds projects in every state, the District of Columbia, Puerto Rico, Guam, and the U.S. Virgin Islands.
Fifth, the Centers for Medicare & Medicaid Services, in conjunction with the Administration on Aging, will be launching an educational media campaign this summer to educate Medicare beneficiaries about the importance of staying vigilant with their personal Medicare information and getting the facts out about the new law so that scam artists are not able to prey on seniors.
The more we can educate the American people about fraud prevention, the better chance we have to protect taxpayer dollars and the Medicare trust fund. The Affordable Care Act also contains some important new tools and resources that will directly help law enforcement officials crack down on fraud.
As you are well aware, fraud schemes have plagued public and private health care plans for decades. Fraudsters have been stealing billions of dollars a year from Medicare, Medicaid, and private health insurers. A year ago, our Departments joined forces to combat fraud in federal health programs. Through the establishment of the Health Care Fraud Prevention Enforcement Action Team (HEAT), we have expanded special anti-fraud Medicare Fraud Strike Forces into seven cities, developed sophisticated new techniques of fraud prevention data analysis, and redirected program integrity resources to fraud hot spots.
Building on our record of aggressive action, we will use the new tools and resources provided by the Affordable Care Act to further crack down on fraud. These include new criminal and civil penalties, enhanced information technology to track and prevent fraud in the first place, and new authorities to prevent bad actors from billing Medicare and Medicaid. HHS has already issued the first set of fraud prevention regulations required under the new health law. These regulations strengthen provider enrollment requirements to ensure we have the ability to better identify, screen, and audit providers and claims.
As we do our part in Washington, we want to work closely with you and other state officials to fight fraud. In that vein, the Affordable Care Act also strengthens state officials’ ability to detect and root out Medicaid fraud. For example, the law provides new access to Medicaid data for the Secretary of HHS that will help both states and the Administration to coordinate anti-fraud activities and gives states greater incentives and flexibility in identifying and collecting Medicaid overpayments. It also helps to promote enhanced information technology to track and prevent fraud, including predictive modeling techniques that can identify abusive or fraudulent billing patterns, audits, and a shared provider database for pre-enrollment screening and post-enrollment anomaly monitoring.
Securing health care coverage, affordability, and choices for Americans requires hard work and vigilance. We stand ready to serve as a resource and partner for you as we work together to fight fraud, implement the provisions of the new health reform law, and strengthen our health care system.
Sincerely,
Eric Holder
Attorney General
Kathleen Sebelius
Secretary of Health and Human Services
-----
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“We are heading into the week when our first tax-free $250 donut hole rebate checks will be mailed out to Medicare beneficiaries who have fallen into the coverage gap. Accordingly, we are especially concerned about fraud and increased activity by criminals seeking to defraud seniors – and we are seeking your help to stop it,” said Secretary Sebelius and Attorney General Holder in the letter. “Building on our record of aggressive action, we will use the new tools and resources provided by the Affordable Care Act to further crack down on fraud.”
In the letter, the Secretary and Attorney General outline education and outreach efforts where state attorneys general could make a big difference. These include efforts to cut the improper payment rate, which tracks fraud, waste and abuse in the Medicare Fee for Service program, in half by 2012; a series of regional fraud prevention summits around the country over the next few months; regular health care fraud task force meetings to facilitate the exchange of information with partners in the public and private sector, and to help coordinate anti-fraud effort; HHS’s plans to double the size of the Senior Medicare Patrol and to put more boots on the ground in the fight against Medicare fraud; and a new educational media campaign this summer to educate Medicare beneficiaries about how to protect themselves against fraud.
The full letter follows.
June 8, 2010
Dear Attorney General:
It was a pleasure to have the opportunity to speak with you and your staff a few weeks ago. We wanted to send you a letter summarizing our discussions and following up with some suggestions of ways we can work together to protect the American people from health care fraud.
In the two months since the Affordable Care Act was signed into law, we have made substantial progress on providing better choices for consumers, tackling health care costs, and holding insurance companies accountable. But while we have been hard at work, scam artists and criminals continue to profit from misinformation about the Affordable Care Act.
Since early April, we have heard increasing reports about seniors being asked to provide their Social Security numbers in order to receive a “donut hole” check under the new law, raising concerns about potential identity theft scams. We have fielded consumer complaints about phony insurance policies, and our Senior Medicare Patrols have been receiving a growing number of calls from people across the country reporting potential fraud schemes.
We are heading into the week when our first tax-free $250 donut hole rebate checks will be mailed out to Medicare beneficiaries who have fallen into the coverage gap. Accordingly, we are especially concerned about fraud and increased activity by criminals seeking to defraud seniors – and we are seeking your help to stop it.
The President has asked us to reach out to you and to other federal, state, and local law enforcement officials across the country to mount a substantial outreach campaign to educate seniors and other Medicare beneficiaries about how to prevent scams and fraud. Some important components of these outreach and education efforts, where you and your staff could make a big difference, are described below.
First, the President has directed the Department of Health and Human Services (HHS) to cut the improper payment rate, which tracks fraud, waste and abuse in the Medicare Fee for Service program, in half by 2012.
Second, following on the National Health Care Fraud Summit we co-hosted in Washington earlier this year, the President has asked both our Departments to convene a series of regional fraud prevention summits around the country over the next few months. The first summit will take place in Miami on July 16. Other summits will follow in, for example, Los Angeles, Las Vegas, Detroit, Boston, New York, and Philadelphia.
These summits will bring together top federal and state officials; representatives of federal, state, and local law enforcement; representatives of our agencies; the health care provider community, such as hospitals and doctors; local businesses; the Senior Medicare Patrol; caregivers; and seniors, for a day of panels and training sessions. Your expertise and experience will be instrumental to the success of these events.
Third, at the Attorney General’s request, the Acting Deputy Attorney General has sent a memo to every United States Attorney in the country asking them to convene regular health care fraud task force meetings to facilitate the exchange of information with partners in the public and private sector, and to help coordinate anti-fraud efforts. Most of these meetings will be held quarterly, with some exceptions for smaller districts. All 93 U.S. Attorneys have been asked to put a plan into place and schedule their first meeting by August 16, 2010. We hope that you and your office will take part in these regular exchanges on effective fraud fighting strategies.
Fourth, HHS will be doubling the size of the Senior Medicare Patrol and putting more boots on the ground in the fight against Medicare fraud. Since 1997, HHS and its Administration on Aging have funded Senior Medicare Patrol projects to recruit and train retired professionals and other senior citizens about how to recognize and report instances or patterns of health care fraud. Close to three million Medicare beneficiaries have been educated since the start of the program, and more than one million one-on-one counseling sessions have taken place with seniors or their caregivers. Currently, the Senior Medicare Patrol program funds projects in every state, the District of Columbia, Puerto Rico, Guam, and the U.S. Virgin Islands.
Fifth, the Centers for Medicare & Medicaid Services, in conjunction with the Administration on Aging, will be launching an educational media campaign this summer to educate Medicare beneficiaries about the importance of staying vigilant with their personal Medicare information and getting the facts out about the new law so that scam artists are not able to prey on seniors.
The more we can educate the American people about fraud prevention, the better chance we have to protect taxpayer dollars and the Medicare trust fund. The Affordable Care Act also contains some important new tools and resources that will directly help law enforcement officials crack down on fraud.
As you are well aware, fraud schemes have plagued public and private health care plans for decades. Fraudsters have been stealing billions of dollars a year from Medicare, Medicaid, and private health insurers. A year ago, our Departments joined forces to combat fraud in federal health programs. Through the establishment of the Health Care Fraud Prevention Enforcement Action Team (HEAT), we have expanded special anti-fraud Medicare Fraud Strike Forces into seven cities, developed sophisticated new techniques of fraud prevention data analysis, and redirected program integrity resources to fraud hot spots.
Building on our record of aggressive action, we will use the new tools and resources provided by the Affordable Care Act to further crack down on fraud. These include new criminal and civil penalties, enhanced information technology to track and prevent fraud in the first place, and new authorities to prevent bad actors from billing Medicare and Medicaid. HHS has already issued the first set of fraud prevention regulations required under the new health law. These regulations strengthen provider enrollment requirements to ensure we have the ability to better identify, screen, and audit providers and claims.
As we do our part in Washington, we want to work closely with you and other state officials to fight fraud. In that vein, the Affordable Care Act also strengthens state officials’ ability to detect and root out Medicaid fraud. For example, the law provides new access to Medicaid data for the Secretary of HHS that will help both states and the Administration to coordinate anti-fraud activities and gives states greater incentives and flexibility in identifying and collecting Medicaid overpayments. It also helps to promote enhanced information technology to track and prevent fraud, including predictive modeling techniques that can identify abusive or fraudulent billing patterns, audits, and a shared provider database for pre-enrollment screening and post-enrollment anomaly monitoring.
Securing health care coverage, affordability, and choices for Americans requires hard work and vigilance. We stand ready to serve as a resource and partner for you as we work together to fight fraud, implement the provisions of the new health reform law, and strengthen our health care system.
Sincerely,
Eric Holder
Attorney General
Kathleen Sebelius
Secretary of Health and Human Services
-----
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Wednesday, May 6, 2009
American Association for Homecare Applauds Senate 'STOP' Act, Which Aims to Prevent Medicare Fraud and Abuse
/PRNewswire / -- The American Association for Homecare applauds Senators Mel Martinez (R-Fla.), John Cornyn (R-Tex.), and several others for introducing the "STOP" Act (S. 975) which targets Medicare waste, fraud, and abuse. The Seniors and Taxpayers Obligation Protection (STOP) Act is designed to reduce the billions of dollars lost to waste and fraud every year by creating additional prevention and detection systems for the Medicare program.
The STOP Act will give the Centers for Medicare and Medicaid Services (CMS), the Department of Health and Human Services (HHS), and the Social Security Administration (SSA) more tools needed to prevent waste, fraud, and abuse in the Medicare system before it starts. The bill is co-sponsored by Senators Lamar Alexander (R-Tenn.), Susan Collins (R-Maine), Bill Nelson (D-Fla.), and David Vitter (R-La.), Jim DeMint (R-S.C.), Lindsey Graham (R-S.C.), Bob Corker (R-Tenn).
"The American Association for Homecare has been working closely with Senator Martinez and his staff over the past year to help identify the most effective and direct measures to stop waste, fraud, and abuse in the Medicare program," said American Association for Homecare President Tyler J. Wilson. "We applaud the Senators' efforts to protect patients, seniors, and taxpayers, and we appreciate the fact that provisions in this bill reflect recommendations from our Association's Medicare Anti-Fraud Legislative Action Plan. We also strongly support President Obama's goal of preventing Medicare fraud, which he has identified as a priority in his 2010 budget."
Earlier this year, the American Association for Homecare urged members of Congress to adopt the Medicare Anti-Fraud Legislative Plan. This legislative action plan outlines tough, effective steps to stop waste, fraud, and abuse in Medicare's home medical equipment (HME) sector before it starts. Among the provisions detailed in the legislative proposal are more rigorous quality standards, increased penalties for fraud, mandated site inspections for new providers, and real-time claims analysis. For more information about the Medicare Anti-Fraud Legislative Action Plan, please visit www.aahomecare.org/stopfraud.
The recently introduced STOP Act includes provisions that mirror recommendations from the American Association for Homecare Anti-Fraud Legislative Plan, such as mandates for:
- Pre-enrollment site visits and unannounced site visits for new home medical equipment providers;
- Site visits for current providers that are re-enrolling, as well as an unannounced site visit after re-enrollment;
- Real-time data analysis (like that used to identify credit card charging patterns) to identify and investigate unusual billing and ordering practices that could indicate fraud or abuse; and
- Checks to ensure that the provider is qualified and enrolled to bill the type of item or service that is on the claim for reimbursement.
As Ranking Member of the U.S. Senate Special Committee on Aging, Sen. Martinez will hold a hearing later today to discuss legislative solutions aimed at eliminating Medicare and Medicaid waste, fraud, and abuse. In a statement submitted to the Committee, the American Association for Homecare expressed its support for the Committee's efforts to fight waste in Medicare:
"The Association and its members want to work with Congress, the Administration, and CMS to enact these new steps to prevent criminals from abusing Medicare.... While HME fraud only constitutes a small fraction of overall Medicare fraud, we firmly believe that any abuse of the Medicare system is a disgraceful waste of taxpayers' dollars and represents theft of resources needed by patients, seniors, and individuals with disabilities."
Included in this formal statement was the AAHomecare Medicare Anti-Fraud Legislative Plan that proposes the following 13 specific recommendations to stop fraud and abuse in the homecare sector:
1. Mandate Site Inspections for All New Home Medical Equipment Providers A
July 2008 GAO report underscored the need for CMS to ensure that its
contractors are conducting effective site inspections for all new
applicants for a Medicare supplier number.
2. Require Site Inspections for All HME Provider Renewals All renewal
applications should require an in-person visit by the National Supplier
Clearinghouse (NSC), the contractor that CMS uses to ensure integrity
in the Medicare program.
3. Improve Validation of New Homecare Providers Additional validation of
new providers should be included in a comprehensive and effective
application process for obtaining a Medicare supplier number.
4. Require Two Additional Random, Unannounced Site Visits for All New
Providers Two unannounced site visits should be conducted by NSC during
the first year of operation for new HME providers.
5. Require a Six-Month Trial Period for New Providers The NSC should issue
a provisional, non-permanent supplier number to new suppliers for a
six-month trial period. After six months of demonstrated compliance,
the provider would receive a "regular" supplier number.
6. Establish an Anti-Fraud Office at Medicare CMS should establish an
office with the sole mandate of coordinating detection and deterrence
of fraud and improper payments across the Medicare and Medicaid
programs.
7. Ensure Proper Federal Funding for Fraud Prevention Increase federal
funding to ensure that NSC completes site inspection and other
anti-fraud measures.
8. Require Post-Payment Audit Reviews for All New Providers Medicare's
program safeguard contractors should conduct post-payment sample
reviews for six months worth of claims submitted to Medicare by new
providers.
9. Conduct Real-Time Claims Analysis and a Refocus on Audit Resources
Medicare must analyze billings of new and existing providers in real
time to identify aberrant billing patterns more quickly.
10. Ensure All Providers Are Qualified to Offer the Services They Bill A
cross-check system within Medicare databases should ensure that
homecare providers are qualified and accredited for the specific
equipment and services for which they are billing.
11. Establish Due Process Procedures for Suppliers CMS should develop
written due process procedures for the Medicare supplier number
process, including issuance, denial and revocation of the Medicare
supplier number. The procedures must include, for example, an
administrative appeals process and timelines.
12. Increase Penalties and Fines for Fraud Congress should establish more
severe penalties for instances of buying or stealing beneficiaries'
Medicare numbers or physicians' provider numbers that may be used to
defraud the government.
13. Establish More Rigorous Quality Standards Ensure that all accrediting
bodies are applying the same set of rigorous standards and degree of
inspection to their clients.
-----
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The STOP Act will give the Centers for Medicare and Medicaid Services (CMS), the Department of Health and Human Services (HHS), and the Social Security Administration (SSA) more tools needed to prevent waste, fraud, and abuse in the Medicare system before it starts. The bill is co-sponsored by Senators Lamar Alexander (R-Tenn.), Susan Collins (R-Maine), Bill Nelson (D-Fla.), and David Vitter (R-La.), Jim DeMint (R-S.C.), Lindsey Graham (R-S.C.), Bob Corker (R-Tenn).
"The American Association for Homecare has been working closely with Senator Martinez and his staff over the past year to help identify the most effective and direct measures to stop waste, fraud, and abuse in the Medicare program," said American Association for Homecare President Tyler J. Wilson. "We applaud the Senators' efforts to protect patients, seniors, and taxpayers, and we appreciate the fact that provisions in this bill reflect recommendations from our Association's Medicare Anti-Fraud Legislative Action Plan. We also strongly support President Obama's goal of preventing Medicare fraud, which he has identified as a priority in his 2010 budget."
Earlier this year, the American Association for Homecare urged members of Congress to adopt the Medicare Anti-Fraud Legislative Plan. This legislative action plan outlines tough, effective steps to stop waste, fraud, and abuse in Medicare's home medical equipment (HME) sector before it starts. Among the provisions detailed in the legislative proposal are more rigorous quality standards, increased penalties for fraud, mandated site inspections for new providers, and real-time claims analysis. For more information about the Medicare Anti-Fraud Legislative Action Plan, please visit www.aahomecare.org/stopfraud.
The recently introduced STOP Act includes provisions that mirror recommendations from the American Association for Homecare Anti-Fraud Legislative Plan, such as mandates for:
- Pre-enrollment site visits and unannounced site visits for new home medical equipment providers;
- Site visits for current providers that are re-enrolling, as well as an unannounced site visit after re-enrollment;
- Real-time data analysis (like that used to identify credit card charging patterns) to identify and investigate unusual billing and ordering practices that could indicate fraud or abuse; and
- Checks to ensure that the provider is qualified and enrolled to bill the type of item or service that is on the claim for reimbursement.
As Ranking Member of the U.S. Senate Special Committee on Aging, Sen. Martinez will hold a hearing later today to discuss legislative solutions aimed at eliminating Medicare and Medicaid waste, fraud, and abuse. In a statement submitted to the Committee, the American Association for Homecare expressed its support for the Committee's efforts to fight waste in Medicare:
"The Association and its members want to work with Congress, the Administration, and CMS to enact these new steps to prevent criminals from abusing Medicare.... While HME fraud only constitutes a small fraction of overall Medicare fraud, we firmly believe that any abuse of the Medicare system is a disgraceful waste of taxpayers' dollars and represents theft of resources needed by patients, seniors, and individuals with disabilities."
Included in this formal statement was the AAHomecare Medicare Anti-Fraud Legislative Plan that proposes the following 13 specific recommendations to stop fraud and abuse in the homecare sector:
1. Mandate Site Inspections for All New Home Medical Equipment Providers A
July 2008 GAO report underscored the need for CMS to ensure that its
contractors are conducting effective site inspections for all new
applicants for a Medicare supplier number.
2. Require Site Inspections for All HME Provider Renewals All renewal
applications should require an in-person visit by the National Supplier
Clearinghouse (NSC), the contractor that CMS uses to ensure integrity
in the Medicare program.
3. Improve Validation of New Homecare Providers Additional validation of
new providers should be included in a comprehensive and effective
application process for obtaining a Medicare supplier number.
4. Require Two Additional Random, Unannounced Site Visits for All New
Providers Two unannounced site visits should be conducted by NSC during
the first year of operation for new HME providers.
5. Require a Six-Month Trial Period for New Providers The NSC should issue
a provisional, non-permanent supplier number to new suppliers for a
six-month trial period. After six months of demonstrated compliance,
the provider would receive a "regular" supplier number.
6. Establish an Anti-Fraud Office at Medicare CMS should establish an
office with the sole mandate of coordinating detection and deterrence
of fraud and improper payments across the Medicare and Medicaid
programs.
7. Ensure Proper Federal Funding for Fraud Prevention Increase federal
funding to ensure that NSC completes site inspection and other
anti-fraud measures.
8. Require Post-Payment Audit Reviews for All New Providers Medicare's
program safeguard contractors should conduct post-payment sample
reviews for six months worth of claims submitted to Medicare by new
providers.
9. Conduct Real-Time Claims Analysis and a Refocus on Audit Resources
Medicare must analyze billings of new and existing providers in real
time to identify aberrant billing patterns more quickly.
10. Ensure All Providers Are Qualified to Offer the Services They Bill A
cross-check system within Medicare databases should ensure that
homecare providers are qualified and accredited for the specific
equipment and services for which they are billing.
11. Establish Due Process Procedures for Suppliers CMS should develop
written due process procedures for the Medicare supplier number
process, including issuance, denial and revocation of the Medicare
supplier number. The procedures must include, for example, an
administrative appeals process and timelines.
12. Increase Penalties and Fines for Fraud Congress should establish more
severe penalties for instances of buying or stealing beneficiaries'
Medicare numbers or physicians' provider numbers that may be used to
defraud the government.
13. Establish More Rigorous Quality Standards Ensure that all accrediting
bodies are applying the same set of rigorous standards and degree of
inspection to their clients.
-----
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Thursday, April 16, 2009
84 Members of Congress, Led by Rep. Betty Sutton, Urge Policymakers to Rescind Controversial Medicare 'Competitive' Bidding Rule Before April 18
84 Members of Congress, Led by Rep. Betty Sutton, Urge Policymakers to Rescind Controversial Medicare 'Competitive' Bidding Rule Before April 18 Deadline
/PRNewswire / -- In a letter sent yesterday, a bipartisan group of 84 members of Congress urged the White House Office of Health Reform, the Centers for Medicare & Medicaid Services, and the U.S. Department of Health and Human Services to review and rescind the controversial "competitive" bidding rule before it is implemented on April 18, 2009. Representatives signing the letter include Debbie Wasserman-Schultz (D-Fla.), Marsha Blackburn (R-Tenn.), and John Lewis (D-Ga.).
The bidding program, which was initially suspended by Congress in 2008 because of numerous flaws detected, will lower quality and reduce access to care for seniors and people with disabilities. The current version of the bidding program will put at least 90 percent of providers - many of which are small businesses - out of work at a time when unemployment is high and government is already fighting to protect jobs.
"As growing numbers of seniors enter the Medicare program, it is important that we take care to maintain an adequate number of qualified and capable providers to address demand for care in the home, especially in rural areas," said Betty Sutton, a U.S. Representative from Ohio's 13th District.
The current structure of the program bears no resemblance to earlier demonstration programs in Florida and Texas in 1997 and 1998. The current bidding program is actually anti-competitive because it will selectively contract with a small group of homecare providers based on the lowest bid, forcing out providers who utilize high-quality homecare equipment or provide critical patient services. These selective contracts would result in the immediate elimination of thousands of eligible small businesses throughout the country from the Medicare program.
"Of the more than 4,000 providers in the initial bidding areas, only 376 were deemed to have met the bidding program requirements," said Rep. Sutton, describing the implementation last year. "This is not a solution to Medicare reform and would only reduce quality and access to care for seniors and people with disabilities."
Home medical equipment and care is already the most cost-effective, slowest-growing portion of Medicare spending, increasing only 0.75 percent per year according to the most recent National Health Expenditures data from the federal government. That rate compares to more than 6 percent annual growth for Medicare spending overall. Home medical equipment represents only 1.6 of the Medicare budget.
Please find the full text of the letter below.
April 15, 2009
Mr. Charles Johnson, Acting Secretary
U.S. Department of Health and Human Services
200 Independence Avenue, S.W.
Washington, D.C. 20201
Ms. Charlene Frizzera, Acting Administrator
Centers for Medicare & Medicaid Services
U.S. Department of Health and Human Services
200 Independence Avenue, S.W.
Washington, D.C. 20201
Ms. Nancy-Ann DeParle, Director
White House Office of Health Reform
The White House
Washington, D.C. 20050
Dear Acting Secretary Johnson, Acting Administrator Frizzera and Ms. DeParle:
On January 16, 2009, the Centers for Medicare and Medicaid Services (CMS) published an interim final rule on the durable medical equipment (DME) competitive bidding program effective April 18, 2009. We are deeply concerned that CMS has rushed implementation of this rule counter to Congress' intent when it delayed the competitive bidding program as part of the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA). As such, we urge you to rescind the rule so that all affected parties will have an opportunity to comment on it as a proposed regulation.
In the initial implementation of the durable medical equipment competitive bidding program, many questions were raised as to the immediate impact of the program on quality and access to care for patients. Of particular concern was the immediate elimination of thousands of eligible providers throughout the country from the Medicare program. Of the more than 4,000 providers in the initial bidding area, only 376 were deemed to have met the bidding program requirements, which were not clearly defined by CMS and its contractor. As growing numbers of seniors enter the Medicare program, it is important that we take care to maintain an adequate number of qualified and capable providers to address demand for care in the home, especially in rural areas.
The agency's stated rationale in its interim final rule for not electing to pursue the traditional notice and comment rulemaking was that the statutory language was highly prescriptive and it would be redundant to propose a rule to incorporate the words of a provision already contained in statute. In fact, we remain concerned that many of the recommended changes designed to prevent future access problems and confusion in the competitive bid process were not incorporated or even raised for public comment. Any final rulemaking on this program should at a minimum provide assurances that the alleged discrepancies between information submitted by bidders and received by CMS will not again result in the unfair disqualification, without appeal, of longstanding companies in our states who have offered quality homecare for decades. CMS also needs to ensure that its contractor is consistently and properly applying the standards established to qualify suppliers for participation in the program, notably a supplier's demonstrated capacity to serve a given area and patient population.
We agree that MIPPA addressed near-term concerns with the program, but thoughtful and deliberate rulemaking by CMS was clearly anticipated by Congress. Under the circumstances, it would be much more appropriate for CMS to utilize traditional notice and comment rulemaking ensuring a collaborative and transparent process, and program success.
Thank you for your consideration and we look forward to your response.
Signing members below.
Signers of April 15, 2009 Congressional Letter to CMS re Competitive Bidding Interim Final Rule
Alabama
Rep. Robert Aderholt (R)
California
Rep. Joe Baca (D)
Rep. Sam Farr (D)
Connecticut
Rep. Joe Courtney (D)
Florida
Rep. Gus Bilirakis (R)
Rep. Kathy Castor (D)
Rep. Lincoln Diaz-Balart (R)
Rep. Mario Diaz-Balart (R)
Rep. Alan Grayson (D)
Rep. Alcee Hastings (D)
Rep. Ron Klein (D)
Rep. Kendrick Meek (D)
Rep. Adam Putnam (R)
Rep. Debbie Wasserman-Schultz (D)
Rep. Robert Wexler (D)
Georgia
Rep. John Barrow (D)
Rep. Sanford Bishop (D)
Rep. Hank Johnson (D)
Rep. John Lewis (D)
Rep. Lynn Westmoreland (R)
Illinois
Rep. Jerry Costello (D)
Indiana
Rep. Joe Donnelly (D)
Rep. Peter Visclosky (D)
Iowa
Rep. Bruce Braley (D)
Rep. Tom Latham (R)
Rep. Rep. David Loebsack (D)
Kentucky
Rep. Geoff Davis (R)
Maine
Rep. Michael Michaud (D)
Maryland
Rep. John Sarbanes (D)
Massachusetts
Rep. William Delahunt (D)
Rep. Barney Frank (D)
Rep. John Olver (D)
Rep. John Tierney (D)
Mississippi
Rep. Travis Childers (D)
Missouri
Rep. Emanuel Cleaver (D)
Rep. Blaine Luetkemeyer (R)
Nevada
Rep. Shelley Berkley (D)
Rep. Dina Titus (D)
New Jersey
Rep. John Adler (D)
Rep. Frank LoBiondo (R)
Rep. Albio Sires (D)
Rep. Chris Smith (R)
New York
Rep. Gary Ackerman (D)
Rep. Michael Arcuri (D)
Rep. Tim Bishop (D)
Rep. John Hall (D)
Rep. Brian Higgins (D)
Rep. Maurice Hinchey (D)
Rep. Steve Israel (D)
Rep. Peter King (R)
Rep. Christopher Lee (R)
Rep. Nita Lowey (D)
Rep. Carolyn Maloney (D)
Rep. Eric Massa (D)
Rep. Carolyn McCarthy (D)
Rep. Mike McMahon (D)
Rep. Gregory Meeks (D)
Rep. Edolphus Towns (D)
North Carolina
Rep. Bob Etheridge (D)
Rep. Larry Kissell (D)
Rep. Sue Myrick (R)
Rep. David Price (D)
Rep. Heath Shuler (D)
Ohio
Rep. Robert Latta (R)
Rep. Jean Schmidt (R)
Rep. Betty Sutton (D)
Oklahoma
Rep. Dan Boren (D)
Pennsylvania
Rep. Jason Altmire (D)
Rep. Kathy Dahlkemper (D)
Rep. Tim Murphy (R)
Rep. Bill Shuster (R)
South Carolina
Rep. John Spratt (D)
Rep. Joe Wilson (R)
Tennessee
Rep. Marsha Blackburn (R)
Texas
Rep. Henry Cuellar (D)
Rep. Chet Edwards (D)
Rep. Charles Gonzalez (D)
Rep. Kay Granger (R)
Rep. Eddie Bernice Johnson (D)
Rep. Ted Poe (R)
Rep. Pete Sessions (R)
Rep. Lamar Smith (R)
Virginia
Rep. Tom Perriello (D)
Rep. Robert Wittman (R)
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/PRNewswire / -- In a letter sent yesterday, a bipartisan group of 84 members of Congress urged the White House Office of Health Reform, the Centers for Medicare & Medicaid Services, and the U.S. Department of Health and Human Services to review and rescind the controversial "competitive" bidding rule before it is implemented on April 18, 2009. Representatives signing the letter include Debbie Wasserman-Schultz (D-Fla.), Marsha Blackburn (R-Tenn.), and John Lewis (D-Ga.).
The bidding program, which was initially suspended by Congress in 2008 because of numerous flaws detected, will lower quality and reduce access to care for seniors and people with disabilities. The current version of the bidding program will put at least 90 percent of providers - many of which are small businesses - out of work at a time when unemployment is high and government is already fighting to protect jobs.
"As growing numbers of seniors enter the Medicare program, it is important that we take care to maintain an adequate number of qualified and capable providers to address demand for care in the home, especially in rural areas," said Betty Sutton, a U.S. Representative from Ohio's 13th District.
The current structure of the program bears no resemblance to earlier demonstration programs in Florida and Texas in 1997 and 1998. The current bidding program is actually anti-competitive because it will selectively contract with a small group of homecare providers based on the lowest bid, forcing out providers who utilize high-quality homecare equipment or provide critical patient services. These selective contracts would result in the immediate elimination of thousands of eligible small businesses throughout the country from the Medicare program.
"Of the more than 4,000 providers in the initial bidding areas, only 376 were deemed to have met the bidding program requirements," said Rep. Sutton, describing the implementation last year. "This is not a solution to Medicare reform and would only reduce quality and access to care for seniors and people with disabilities."
Home medical equipment and care is already the most cost-effective, slowest-growing portion of Medicare spending, increasing only 0.75 percent per year according to the most recent National Health Expenditures data from the federal government. That rate compares to more than 6 percent annual growth for Medicare spending overall. Home medical equipment represents only 1.6 of the Medicare budget.
Please find the full text of the letter below.
April 15, 2009
Mr. Charles Johnson, Acting Secretary
U.S. Department of Health and Human Services
200 Independence Avenue, S.W.
Washington, D.C. 20201
Ms. Charlene Frizzera, Acting Administrator
Centers for Medicare & Medicaid Services
U.S. Department of Health and Human Services
200 Independence Avenue, S.W.
Washington, D.C. 20201
Ms. Nancy-Ann DeParle, Director
White House Office of Health Reform
The White House
Washington, D.C. 20050
Dear Acting Secretary Johnson, Acting Administrator Frizzera and Ms. DeParle:
On January 16, 2009, the Centers for Medicare and Medicaid Services (CMS) published an interim final rule on the durable medical equipment (DME) competitive bidding program effective April 18, 2009. We are deeply concerned that CMS has rushed implementation of this rule counter to Congress' intent when it delayed the competitive bidding program as part of the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA). As such, we urge you to rescind the rule so that all affected parties will have an opportunity to comment on it as a proposed regulation.
In the initial implementation of the durable medical equipment competitive bidding program, many questions were raised as to the immediate impact of the program on quality and access to care for patients. Of particular concern was the immediate elimination of thousands of eligible providers throughout the country from the Medicare program. Of the more than 4,000 providers in the initial bidding area, only 376 were deemed to have met the bidding program requirements, which were not clearly defined by CMS and its contractor. As growing numbers of seniors enter the Medicare program, it is important that we take care to maintain an adequate number of qualified and capable providers to address demand for care in the home, especially in rural areas.
The agency's stated rationale in its interim final rule for not electing to pursue the traditional notice and comment rulemaking was that the statutory language was highly prescriptive and it would be redundant to propose a rule to incorporate the words of a provision already contained in statute. In fact, we remain concerned that many of the recommended changes designed to prevent future access problems and confusion in the competitive bid process were not incorporated or even raised for public comment. Any final rulemaking on this program should at a minimum provide assurances that the alleged discrepancies between information submitted by bidders and received by CMS will not again result in the unfair disqualification, without appeal, of longstanding companies in our states who have offered quality homecare for decades. CMS also needs to ensure that its contractor is consistently and properly applying the standards established to qualify suppliers for participation in the program, notably a supplier's demonstrated capacity to serve a given area and patient population.
We agree that MIPPA addressed near-term concerns with the program, but thoughtful and deliberate rulemaking by CMS was clearly anticipated by Congress. Under the circumstances, it would be much more appropriate for CMS to utilize traditional notice and comment rulemaking ensuring a collaborative and transparent process, and program success.
Thank you for your consideration and we look forward to your response.
Signing members below.
Signers of April 15, 2009 Congressional Letter to CMS re Competitive Bidding Interim Final Rule
Alabama
Rep. Robert Aderholt (R)
California
Rep. Joe Baca (D)
Rep. Sam Farr (D)
Connecticut
Rep. Joe Courtney (D)
Florida
Rep. Gus Bilirakis (R)
Rep. Kathy Castor (D)
Rep. Lincoln Diaz-Balart (R)
Rep. Mario Diaz-Balart (R)
Rep. Alan Grayson (D)
Rep. Alcee Hastings (D)
Rep. Ron Klein (D)
Rep. Kendrick Meek (D)
Rep. Adam Putnam (R)
Rep. Debbie Wasserman-Schultz (D)
Rep. Robert Wexler (D)
Georgia
Rep. John Barrow (D)
Rep. Sanford Bishop (D)
Rep. Hank Johnson (D)
Rep. John Lewis (D)
Rep. Lynn Westmoreland (R)
Illinois
Rep. Jerry Costello (D)
Indiana
Rep. Joe Donnelly (D)
Rep. Peter Visclosky (D)
Iowa
Rep. Bruce Braley (D)
Rep. Tom Latham (R)
Rep. Rep. David Loebsack (D)
Kentucky
Rep. Geoff Davis (R)
Maine
Rep. Michael Michaud (D)
Maryland
Rep. John Sarbanes (D)
Massachusetts
Rep. William Delahunt (D)
Rep. Barney Frank (D)
Rep. John Olver (D)
Rep. John Tierney (D)
Mississippi
Rep. Travis Childers (D)
Missouri
Rep. Emanuel Cleaver (D)
Rep. Blaine Luetkemeyer (R)
Nevada
Rep. Shelley Berkley (D)
Rep. Dina Titus (D)
New Jersey
Rep. John Adler (D)
Rep. Frank LoBiondo (R)
Rep. Albio Sires (D)
Rep. Chris Smith (R)
New York
Rep. Gary Ackerman (D)
Rep. Michael Arcuri (D)
Rep. Tim Bishop (D)
Rep. John Hall (D)
Rep. Brian Higgins (D)
Rep. Maurice Hinchey (D)
Rep. Steve Israel (D)
Rep. Peter King (R)
Rep. Christopher Lee (R)
Rep. Nita Lowey (D)
Rep. Carolyn Maloney (D)
Rep. Eric Massa (D)
Rep. Carolyn McCarthy (D)
Rep. Mike McMahon (D)
Rep. Gregory Meeks (D)
Rep. Edolphus Towns (D)
North Carolina
Rep. Bob Etheridge (D)
Rep. Larry Kissell (D)
Rep. Sue Myrick (R)
Rep. David Price (D)
Rep. Heath Shuler (D)
Ohio
Rep. Robert Latta (R)
Rep. Jean Schmidt (R)
Rep. Betty Sutton (D)
Oklahoma
Rep. Dan Boren (D)
Pennsylvania
Rep. Jason Altmire (D)
Rep. Kathy Dahlkemper (D)
Rep. Tim Murphy (R)
Rep. Bill Shuster (R)
South Carolina
Rep. John Spratt (D)
Rep. Joe Wilson (R)
Tennessee
Rep. Marsha Blackburn (R)
Texas
Rep. Henry Cuellar (D)
Rep. Chet Edwards (D)
Rep. Charles Gonzalez (D)
Rep. Kay Granger (R)
Rep. Eddie Bernice Johnson (D)
Rep. Ted Poe (R)
Rep. Pete Sessions (R)
Rep. Lamar Smith (R)
Virginia
Rep. Tom Perriello (D)
Rep. Robert Wittman (R)
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Wednesday, February 11, 2009
Stealth Rationing of Medical Care Sneaks Into the 'Stimulus' Bill, Says the Association of American Physicians and Surgeons (AAPS)
/PRNewswire-USNewswire/ -- Unwanted "change" is coming to senior citizens and all those needing medical care if the stealth rationing in the "stimulus" bill becomes law. Rationing of medical care has nothing to do with stimulating the economy, but it was inserted into the bill before the public realized it.
As the disgraced Tom Daschle planned, the government will gain control over medical care incrementally. The stimulus bill seeks to lay the foundation for rationing and denying care to the elderly and the infirm by setting up the infrastructure for monitoring the treatment of all Americans. Doctors who are not "meaningful users" of the system will be punished by fee cuts.
Americans do not want to imitate Canada and England, where patients are told they are too old to receive a necessary operation or must sit on a long waiting list. It can take over a year in those countries before someone sees a doctor for treatment of a life-threatening condition, such as cancer.
But under the rationing inserted into the stimulus bill, Medicare will no longer pay for safe and effective care. Instead, it would apply a standard of cost-effectiveness in order to ration or deny care to the elderly and those who are sickest.
The stealth provisions of this bill create a massive new bureaucracy for controlling medicine, giving this new bureaucracy more money than the stimulus bill provides to all of our armed forces combined.
The lynchpin of this government takeover is to start building a national electronic database of medical records. Patient privacy will be impossible, and mistakes in medical records will be nearly impossible to delete.
This plan will lead to enormous new costs for doctors' offices and patients, but insurance companies are determined to have full access to patients' medical records, and the stimulus bill will enable that. Employers also want access to private medical records to prove fitness for work.
-----
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As the disgraced Tom Daschle planned, the government will gain control over medical care incrementally. The stimulus bill seeks to lay the foundation for rationing and denying care to the elderly and the infirm by setting up the infrastructure for monitoring the treatment of all Americans. Doctors who are not "meaningful users" of the system will be punished by fee cuts.
Americans do not want to imitate Canada and England, where patients are told they are too old to receive a necessary operation or must sit on a long waiting list. It can take over a year in those countries before someone sees a doctor for treatment of a life-threatening condition, such as cancer.
But under the rationing inserted into the stimulus bill, Medicare will no longer pay for safe and effective care. Instead, it would apply a standard of cost-effectiveness in order to ration or deny care to the elderly and those who are sickest.
The stealth provisions of this bill create a massive new bureaucracy for controlling medicine, giving this new bureaucracy more money than the stimulus bill provides to all of our armed forces combined.
The lynchpin of this government takeover is to start building a national electronic database of medical records. Patient privacy will be impossible, and mistakes in medical records will be nearly impossible to delete.
This plan will lead to enormous new costs for doctors' offices and patients, but insurance companies are determined to have full access to patients' medical records, and the stimulus bill will enable that. Employers also want access to private medical records to prove fitness for work.
-----
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