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An excerpt from a VGM Legislative Update email reminds us that CMS is all about saving it's bacon when it comes time to report to it's pork barrel loving bosses, the U.S. Congress. It's not enough that we are responsible to make sure the Dr.'s notes actually back up the CMN they sign, we are also fingered as the biggest de-frauders of the people and the system that we serve. And it's all your fault!
CMS Staff Briefs Congress on Competitive Bidding, and Slams the Industry
Yesterday, CMS hosted a congressional briefing on competitive bidding for the durable medical equipment (DME) in Medicare. Senior CMS officials outlined the agency's work on the competitive bidding program, summarized efforts to expand bidding to an additional 70 areas, and slammed the industry as a hotbed of fraud.
During the briefing, CMS staff claimed that DME fraud is the largest area of fraud in the Medicare program, the biggest loss to the program, and the biggest vulnerability in the program.
However, CMS staff did not describe their agency's accountability for failing to prevent criminals from obtaining Medicare supplier numbers.
Nor did CMS provide the math for how, exactly, the DME sector, about 1.7 percent of Medicare spending, could account for the largest amount of fraud in the entire Medicare program, which spends more than $400 billion per year. CMS estimates that the total cost of fraud across all sectors of Medicare is somewhere between $40 billion to $80 billion per year. So the agency's own margin of error for calculating Medicare fraud is many times greater than the total DME spending in Medicare.
Under the current system, CMS staff said, it is too easy for fraudulent suppliers to look like they meet all of the quality standards when they get their initial site visit from the National Supplier Clearinghouse and further claimed that suppliers do not uphold the standards once they have their provider number.
CMS suggested that there are116,000 DME suppliers enrolled in the Medicare program that collectively bill more than $10 billion per year and provide services to about 10 million beneficiaries per year (about one quarter of all Medicare beneficiaries).
According to CMS staff, there is no product category for mail order diabetic supplies in round two because CMS is planning on having a national mail order diabetic program in the near future, which they are hoping can begin in 2010.
Whoah! So now the government is going to actually become a supplier? Is this a first tentative step towards the slippery slope of nationalized DME? Will grandma have to go stand in line at the Federal Oxygen Administration office, next to the DMV, to refill her tanks or have her concentrator hours checked monthly? Rehab will be just like the old Fords. You can have any color wheelchair you want, as long as you like black.So it's obvious that CMS doesn't trust you. How much do you trust them?
