I have been telling anyone who would listen for the past year that the Medicare fraud problem (at least with new suppliers) starts with NSC's failure to perform its fiduciary responsibilities. The 60 Minutes segment on Miami and LA showed how NSC had let multiple crooks into the system. Worse, the intergrity department failed to identify the fraudulent billings until millions had been paid out. Do you not suppose that recovering these funds was less than 100% or that the costs of recovering funds comes out of taxpayers pocket instead of NSC's pocket?
There is a solution. How about ALL DME suppliers pitch in together to have our patients call or write their elected officials to pass legislation to do two things.
First make it where NSC is on the hook with a mega-surety bond to cover the fraudulent billings of NEW suppliers (and any increase in NSC's surety bond premium cannont be passed on to the taxpayer - has to come off their bottom line). The amount of the bond should be in the amount of what OIG report says occurred from new suppliers the previous year. NSC will have to do ramp up doing their job then to inspect sites and to give out supplier numbers to legit individuals. What do you want to bet that the reporting of fraud will become very accurate and not include billing errors due to overly complex rules and regulations?
Second all NEW suppliers must have a credit limit so if they smoke NSC's inspectors and/or staff, the new supplier cannot bill hundreds of thousands of dollars per day of fraudulent claims during the first 90 days of having a new number. Realistically, what new legitimate supplier is able to provide that amount of services? And if they believe they can, then have legislation in place that says the amount paid per quarter to a new supplier is limited to the amount of the supplier's surety bond. This gives the integrity department time to figure out if a supplier is legitimate or not. It gives a legitimate supplier no ceiling other than their ability to buy a larger surety bond to cover a business plan that exceeds say $15,000 a month in billings that a $50,000 bond covers for 90 days of billings.
Tired of being the whipping boy (or girl) of Medicare because of fraudulent suppliers that NSC let in and that the DMERCs paid fraudulent claims for 90 days? These two approaches solve both issues. But it takes your beneficiaries asking their elected officials to enact legislation. NSC and DMERC insurance companies are not going to change their behavior unless made to by law.
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