HHS has announced an effort to prevent sham billing for durable medical equipment, prosthetics, orthotics and supplies in Los Angeles and South Florida, the top two areas where the government has uncovered abundant fraud.
In what is described as a demonstration project, 7,700-plus providers in Los Angeles and South Florida will receive letters within the next two months notifying them they have to reapply for billing privileges within 30 days. The agency promises to deploy additional investigators to ensure anyone with a billing number gets at least one unannounced site visit within the next two years.
The geographic crackdown will expand if it is successful and if data suggest fraudulent activity in other places and service areas, said Leslie Norwalk, acting CMS administrator.
The point of the demonstration project is to keep the fraudulent providers out of the program before they rip us off, Norwalk said in a phone conference with reporters held yesterday.
Raul Lopez, president of the Florida Association of Medical Equipment Services, said that the timing of the action could be burdensome because providers in the targeted area are facing a deadline for competitive bids and accreditation newly required under the Medicare Modernization Act of 2003.
Lopez, director of operations for BayShore Dura Medical in Miami Lakes, Fla., also said the fraud schemes make it harder to do business as he gets patients whose information has been flagged by the government because it was used fraudulently. It actually is very time consuming and my payment delays are huge, Lopez said. -- by Gregg Blesch