Friday, April 25, 2014

Fraud & Abuse

How can our industry, DME/HME, stop fraud and abuse? I have spent many a sleepless night thinking about what we could do. Speaking with many experts about F&A, I believe there is an answer.

When there are few regulations, not very specific guidelines, and a large cornucopia of money, it becomes an opportunity for F&A. This will attract unscrupulous people who see DME/HME as a chance to harvest many dollars!

I am a Registered Pharmacist. After four years in college, studying and learning, I had to pass very strict tests that proved that I was competent. To be a DME dealer, all you have to do is open a store and hang up your sign!

When I went to open my first pharmacy, after passing all the inspections and following instructions to the letter, I was granted my license. All pharmacies throughout the country face unannounced inspections to determine that they are following all rules and regulations.
Accreditation Alone is Not Enough 
The DME/HME profession has made a giant step via ACCREDITATION. This is the first program made to bring recognition of the importance of health care providers. Another thing that must be done is to issue a license. Can the accreditation (license) be suspended or revoked? Yes, and then until corrected, the dealer will be unable to participate in Medicare. When that becomes a fact, it will help keep out many charlatans.

There must be specific standards for both the dealers and the services. I am asking Congress (with CMS and Medicare) to prepare rules, regulations, and standards. To be a DME/HME provider or dealer, the principal must earn their license. This industry must operate, as does pharmacy, by licensure. Physicians, nurses, and therapists all require they meet the standards to participate. So must we!

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