AAHomecare supports detection efforts in wake of cath fraud reports

WASHINGTON – AAHomecare has issued a statement affirming its support for the government to implement real-time monitoring of claims to detect potential fraud and abuse in response to news reports of potential Medicare fraud by a handful of intermittent catheter companies. 

AAHomecare's statement, which was shared with CMS and Capitol Hill, also reiterates recommendations for federal government initiatives to better monitor DME supplier billing practices and trends, including: 

• Increased monitoring and scrutiny of claims submitted by DME suppliers who are new to the Medicare program. 

• Increased monitoring and scrutiny of claims submitted by DME suppliers that submit claims for new product categories. 

• Closer monitoring of significant increases or spikes in claims submissions for a specific product category over a short period of time. 

• Support of electronic prescribing between physicians and suppliers, which would only allow legitimate and verifiable prescriptions for the benefit and safety of patients while allowing payer insight to mitigate abusive billing practices. 

Additionally, the association’s statement notes that the industry has been working in collaboration with clinical, patient and disability organizations to convince CMS to refine the HCPCS coding system for intermittent catheters.   

“We will continue to advocate for a more nuanced HCPCS coding system for intermittent catheters that would provide program integrity benefits and remain committed to working with policymakers to reduce and eliminate fraud and abuse related to intermittent catheters and the full spectrum of DME products and services,” said AAHomecare.