If durable medical equipment (DME) is an unfamiliar term don’t feel lost. Most Americans do not need services from DME suppliers yet. But patients managing long term conditions such as diabetes, for example, are probably much more familiar with what DME means and the companies involved in providing such products and related services. Those health care customers will probably note that some DME suppliers are very good while others are not quite as good. But aside from the good and not-so-good there are also DME suppliers that are skirting rules and regulations or in some cases committing outright fraud. These companies cost U.S. tax payers, patients, insurance companies, and legitimate DME suppliers in a number of ways. Not surprisingly the Centers for Medicare and Medicaid Services (CMS) (www.cms.gov) have specifically named DME suppliers on its list of most likely offenders where insurance fraud is concerned. The level and type of scrutiny that this will draw is likely to reveal that many DME suppliers are not playing by the rules and could also result in more difficulty for companies entering this growing industry. This scrutiny is likely to only increase as entities like the Office of Inspector General (OIG) press CMS to tighten its oversight of DME suppliers.
In 2010 health care costs in the U.S. grew to greater than 17% of the country’s gross domestic product and by 2020 some estimates have that percentage growing to 20% or more. With the percentage of the U.S. population aged 65 or greater nearing 15%, a great quantity of overall health care spending is now shouldered by Medicare and other public health insurance programs. These trends are both expected to continue increasing and with so much spending by the U.S. Government on health services such as DME supplies the consequences of letting DME suppliers have a long leash to run on are growing greater with each passing year.
In December 2011 CMS released a fact sheet which was still available on its website at the time this article was published. Titled “The Obama Administration and Expanded Efforts to Fight Fraud”, this fact sheet outlined some of the efforts CMS is taking to combat Medicare and Medicaid fraud and recover money paid to companies for products or services that were not compliant with the rules and regulations governing those programs. These included enhanced screening of companies that apply for approval by CMS as new suppliers. For DME suppliers that are deemed to be high risk for one reason or another these enhanced screening requirements could include criminal background checks of all individuals involved in the companies as well as on-site visits to their offices prior to being permitted to bill Medicare for any products or services.
For the legitimate companies within the DME supplier industry the heightened inquiries and requirements set by CMS do not necessarily hurt their businesses. Even so, groups representing the DME supply companies’ interests as a legitimate and law-abiding industry and even patients’ groups concerned with the possible delays in health care services that could result from some cautionary and overspending prevention programs are active in voicing their counter concerns to CMS. New competitive bidding requirements, for example, have been accused of setting some patients up for delays in receiving treatment or medical supplies. All around the concerns are real and important and the debate is not likely to cool down soon. For patients already using compliant DME suppliers for their health care needs these controversies and new restrictions may have less impact. But in time even patients like these may notice changes that affect the speed with which certain medications or supplies are provided to them. If this happens the push back by Medicare and Medicaid recipients is only going to increase.