Wednesday, February 15, 2012

Is There No End?

It seems that everyday in the newspapers we find reports of more and more fraud and abuse in the health care system. Yet since I know many dealers and providers, and communicate with their state and national associations, I will make the following statement: “Fraud and abuse does NOT come from providers, but from outside sources who take advantage of an antiquated system designed for reimbursement.”

The system is at fault, not the dealers or providers. According to an article this week (Associated Press) in 2011 the Feds found $4.1 BILLION dollars in health care fraud. That sounds like a great deal of money, but the next paragraph said that they estimated anywhere from 60 to 90 billion dollars a year was being siphoned out of the system.

The average DME/HME dealers are the hardest working proprietors who operate their companies honestly. They are not the culprits. They give away more service and care Pro Bono than any other industry. So what can be done to stop this thievery?

The first thing that has to be accomplished is that every dealer or provider has to earn a license. We have made great progress in that direction and now must go one step further. Accreditation is a fantastic step forward and those dealers who meet and maintain these standards are to be recognized.

It appears that fraud and abuse has become such a major “industry” with developing networks that operate for a few years, milk many dollars, and when uncovered they disappear. Many new “Jack, the Crook” operations are popping up. Why not? When Jack the Crook is discovered selling narcotics he goes to jail, but when he is caught stealing from Medicare, he closes his business and re-opens the next day with a different name. That being the case, the first step has to be earning a license to provide health care supplies, one which can be revoked or suspended.

Is there no end to fraud and abuse? We have to be diligent. We have to work with our state DME associations and support the national associations. At Medtrade this Spring, in Las Vegas, you can speak to all of them and sign on to fight for survival and keep out all the “Jack the Crook” operations.

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