Home-healthand medical transport companies in crosshairs

What to make of the federalgovernment extending its moratorium on allowing new medical providers to bill Medicare and Medicaid insix states?

Does CMS still need to geta handle on pre-screening providers before allowing them to bill?

Or is fraud is so rampantin those areas that CMS must weed out existing bad actors before allowing newproviders to enter?

Probably both.

Shutting down enrollment isa drastic move that can hurt honest providers. It also can limit patient accessto needed care. But it’s a necessary step for the federal government to effectively manage fraud in its programs.

The areas affected by theextension include home-healthcare and medical transport — two that are rifewith fraud.

Congress gave CMS the powerto shut down enrollments a few years ago, but CMS hesitated at first. Nudged byCongress, CMS started restricting enrollments in limited areas where fraud wasmost out of control.

The enrollments seem to bea qualified success, but it will take a few years to fully know if provider fraudhas started moving downward.

In the meantime, CMS istaking a smart approach to using its power to restrict enrollments. Moratoriaare targeted. The latest extensions, for example, impose home-health enrollmentlimits in Florida on just three of the worst counties. Plus, CMS now allowsexceptions to the moratoria if providers pass heightened screening.

Taking action beforecrooked providers can bill is the best answer to the old “pay-and-chase” model.It should also deter many would-be cheaters, especially organized fraud ringslooking to soak federal programs.

About the author: DennisJay is executive director of the CoalitionAgainst Insurance Fraud.

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Regularly updated fraudnews and trend information are accessible for the first time to smartphone andiPad users through a new mobile app from the Coalition Against Insurance Fraud.

The new app FraudWireallows convenient viewing of regularly updated Coalition information that’s inhigh demand within the anti-fraud community.

Available are daily andweekly fraud news … weekly blogs … podcasts ... videos … trend articles bynoted experts, and other fresh insurance-fraud information. They’re formattedfor easy viewing on mobile screens.

FraudWire is available inthe Apple store for iPhone and iPad users, and from Google Play for Androidusers. “Convenient access to fresh fraud information in the subway, hallway orairport is a clear work convenience to fraud fighters who rely on access toupdated news and trend analyses in as close to real time as possible,” saidDennis Jay, executive director of the Coalition.

Users can navigate theCoalition app by information category, tag and a search tab. Real-timenotifications of late-breaking fraud news also are available.

FraudWire reflects acontinued shift to app-driven smartphones and tablets as primary platforms foraccessing digital information. Mobile devices continue outperforming desktopsand laptops as preferred information sources in recent years. The shift is especiallymarked for Millennials.

Nearly 40 percent ofvisitors accessed InsuranceFraud.org via mobile devices this year. Less thanhalf of visitors accessed the Coalition’s website via Windows.

Ingeneral:

·       Average daily Internet usage for mobiledevices grew 600 percent from 2010 to 2015, while desktop/laptop usageflattened;

·       Mobile apps account for 54 percent of timespent consuming digital media; and

·       62 percent of digital media usage time isspent on a mobile device.

“America is ananywhere-anytime information economy. This is especially true of fraudfighters. An app that allows instant access to freshly updated fraudinformation provides a job benefit for frontline fraud fighters and amanagement gain for decisionmakers,” Jay said.

The Coalition AgainstInsurance Fraud is a national alliance of insurers, government agencies andconsumers dedicated to combating all forms of insurance fraud through publicadvocacy, consumer education and research. Founded in 1993, the Coalitionconsists of 145 state, national and international organizations.

******

CONTACT:

Dennis Jay, executivedirector; 202-393-7333

James Quiggle, director ofcommunications; 202-393-7331

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