Former CMS official: The audit process 'is not working'

WASHINGTON - HME providers beleaguered by an onslaught of audits may take some comfort knowing that there is awareness among lawmakers that something needs to change.

"There is collective concern on Capitol Hill about the role of auditors and CMS's oversight of them," said Kimberly Brandt, chief investigative counsel for the Senate Finance Committee and a former CMS official. "We have heard loud and clear that this process is not working, it's not working well at all, and we want something to be done."

Brandt was speaking during a webinar last week hosted by The VGM Group and Munsch Hardt Kopf & Hardy. VGM is one of several industry groups collecting recommendations from providers about anti-fraud efforts in response to a request from the Senate Finance Committee in May.

At the top of the list of the recommendations already in, stakeholders say: more oversight of and standards for auditors.

"The overwhelming problem is that they have unfettered discretion to operate as they please given the lack of judicial overview and qualified immunity," said Edward Vishnevetsky, an attorney at Munsch Hardt. "They are, to an extent, above the law."

To be sure, industry stakeholders have weighed in on fraud and abuse efforts in the past.

"We've been making recommendations on measures for several years now," said Walt Gorski, vice president of government affairs for AAHomecare, which has a 13-point plan to reduce fraud. "Our goal is to make sure fraudulent criminals are eliminated while simplifying the audit and coverage systems so that HME providers can do what they do best—care for patients."

The Senate Finance Committee plans to spend the summer gathering further feedback from those who submitted comments, including industry stakeholders. A summary document with proposed best practices and ideas is expected this fall, Brandt says.

"Hopefully, when the new Congress convenes (in 2013), we'll have something fully vetted and thought out," she said.