Let's raise industry standards

Friday, May 31, 2002

Fraud and abuse. Mention it to an HME provider and, no matter how serious the implications, it's hard to keep your eyes open. It's like when experts start talking about HIPAA. It's like listening to someone tell you about a marketing plan predicated on graying baby boomers. It's like… can we please not talk about this again, or if we do, can you tell me something I don't know?

Maybe. Did you know that there are 106,866 DMEPOS supplier numbers (at last count) in the United States? That there are that many locations dispensing DMEPOS in the states? And they're active too. If you don't bill one of the four DMERCS for four consecutive quarters, the NSC yanks your privilege to bill Medicare.

This has something to do with fraud and abuse. And so does competitive bidding. But first, the number. Medicare doesn't like it. They consider it "a very daunting number," said AAHomecare's Asela Cuervo.

The FBI believes that one out of every 10 DMEPOS provides is a crook, which, if true, means we've got about 10,687 crooks in our midst. Daunting.

But go back to the 106,866. Are we talking about 106,866 healthcare professionals, or as many people who bill Medicare? The answer, says, Jeff Baird of Brown & Fortunato, may be the latter. Why? Maybe because it's much easier to become a DME dealer than a doctor.

"There's no minimum threshold requirement to own a DME," says Baird. "It's not like you've been through years of college. Anybody can get into DME. Not anybody can be a doctor or a pharmacist."

Last month, I talked to a guy who launched his DME business with $300. That's good. This is America. But it stinks for the industry, too. Low barriers to entry let the crooks in.

"I'm not a crook," you say as you read this. "This situation is lousy, but if I run my business down the straight and narrow, it's no sweat off my back, right?"

Maybe not. Competitive bidding is coming down the pike again, this time in a big barreling way. If not for the low barriers to entry, and the crooks who keep spilling over the levee, competitive bidding might not be the haunt it is.

"If you look at where competitive bidding is placed in the BBA, it was not a payment methodology," says Cuervo. "It was a fraud and abuse provision."

So what to do? Lobby Congress. Sure, a handful of DMEPOS suppliers will. With 106,866 out there, a score take the threat to their business, let alone the Medicare patient, seriously enough to fight the initiative or get creative about a solution.

But something else too. "Peer review groups," says the MED Group's David Miller. "Consumer complaint hotlines. An entity where a provider can report suspicious activity without fear that somebody's going to come down on them for slander or libel."

This is part of a plan Miller is circulating to elevate the industry's standards and make it tough for the "bump-and-run" set, as the FBI calls the crooked.

Why not elevate the standards? Because this is America? Because anybody ought to be able to get into this business? Rubbish. Let's raise the standards. Let's pull up the ladder. New Medicare providers are welcome. The ladder will be lowered. But you've got to prove you can climb.

If you're going to bill the taxpayer for the services and products you provide, you ought to have to earn that. It ought not to be a right. It ought to be a privilege. HME