Medicare Durable Medical Equipment and Home Health Fraud Investigations Expected to Intensify in Seven At-Risk States
October 13, 2008
Durable medical equipment ("DME") suppliers and home health agencies in Florida, California, Texas, Illinois, Michigan, North Carolina and New York will be subject to greater scrutiny by federal agents searching for Medicare fraud according to last week's announcement of new fraud-fighting efforts by the Centers for Medicare and Medicaid Services ("CMS"). This announcement can be found on CMS' website in the press release section or by clicking here. CMS Acting Administrator Kerry Weems recognized that many "reputable, caring" companies were providing services, but that some companies were "rotten", prompting his decision to change investigation tactics in the seven states where abuse was most common. With DME companies, CMS is particularly interested in the (tele)marketing and sale of high-end items like powered wheelchairs and oxygen therapy supplies. With home health agencies, CMS is focused on services provided to homebound beneficiaries.
Both home health services and DME suppliers have been the subject of governmental concern for many years. When certain high-end services constitute a significant percentage of a company’s business, that company—regardless of how compliant it may actually be—can become entangled in a lengthy government investigation. Government investigations often include unannounced employee and customer interviews, unannounced site visits, record reviews, computer searches, claims audits, and other activities.
What does this new announcement mean? Many compliant health care companies can find themselves swept up in the tide of such investigations, and advance preparation and guidance can make a significant difference. The Health Care Practice Group at Womble Carlyle has experience with developing and improving compliance programs and company policies and procedures and in navigating through federal investigations.
This client alert is a publication of the Health Care Practice Group at Womble Carlyle Sandridge & Rice, PLLC. Readers are urged to consult with their regular contacts at the firm or Tom Stukes at (336) 574-8065, Tony Brett at (336) 721-3620, Dick Vincent at (404) 879-2422 or Kim Licata at (919) 484-2313.
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