Providers to SBA: Monitoring clipboards won’t curb fraud

‘The new administration is asking how to get rid of the regulations’
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Friday, September 1, 2017

WASHINGTON – From accreditation to audits, HME providers let panel members at a Small Business Administration hearing last week know exactly how they feel about burdensome regulations.

For provider Craig Rae, the cost of maintaining accreditation ranks at the top of his list. He estimates one-third of his staff does nothing but scrutinize minutiae to meet the compliance standards set forth in six categories—the first of which has seven sections containing 113 separate standards requiring documentation.

“Our industry fully supports establishing effective measures to protect beneficiaries and reduce waste, fraud, and abuse, but only a bureaucrat could love what it’s become,” said Rae, owner of Salisbury, N.C.-based Penrod Medical Equipment, at the Aug. 28 hearing in Washington, D.C.  “For example, if a customer leaves a message after hours asking ‘Are you open Saturdays?,’  we need to log the call, what time it came in, and keep a record of when we returned the call.”

Don’t even get him started on HIPAA compliance rules dictating the type of clipboards he can use and the correct way to place documents on those clipboards.

“These things have nothing to do with reducing fraud,” he said. “They are just so far overreaching, telling us how to manage our business.”

Provider Frank Trammell’s key point of contention: audits run amok.

“There’s a lack of transparency and the fact that the different levels of appeal clearly have different rules,” said Trammell, CEO of Matthews, N.C.-based Carolina’s Home Medical Equipment, who restructured his business a few years ago just to keep up.“The denial tends to be rubberstamped at redetermination, and then 80% are being overturned if it makes it in five years to the Administrative Law Judge. We’ve never lost an appeal at the ALJ.”

The SBA holds hearings several times a year around the country and HME providers regularly make it a point to testify. Now, under President Trump’s administration, which has pledged to reduce regulations on business, industry stakeholders hope those efforts will finally pay off.

“After the hearing convened, one of the panel members said they would like us to formulate a letter and get it back to them to be included into their write-up to send to the Department of Health and Human Services, CMS and the administration with the recommendation that the over-burdensome regulations be relieved on small businesses impacted within the HME industry,” said John Gallagher, vice president of government relations for VGM. “The new administration is asking how to get rid of the regulations, so it’s a different ballgame.”