Page 8 - HME Business, May 2019

News / Trends / Analysis
Industry Reacts to Historic Health Fraud Bust
In one of the biggest healthcare frauds in U.S. history, the Feds round up DMEs, telemarketers and medical professionals in a $1.2 billion orthopedic brace scam; various industry insiders share their perspective.
Prochant Releases
HME Metrics
Whitepaper
‘Are You Tracking the Right Metrics?’ examines differences between HME metrics and KPIs and how providers can leverage KPIs to improve their pProfitability.
rochant, which provides outsourced billing and process services to HME businesses, has unveiled a new white paper that discusses
why HME providers aren’t tracking their perfor- mance enough and what KPIs can help them succeed.
Are You Tracking the Right Metrics? makes the case that providers aren’t focusing on the right metrics, and that the metrics they are tracking, such as allowable billing and accounts receivable (A/R) balances, can lead to problems.
Instead, the white paper argues that HME businesses should track industry-standard key performance indicators (KPIs), such as days sales outstanding (DSO), 90+ A/R, payment rate, and write-off rate, because those KPIs are more relevant and useful to their decision-making.
Furthermore, the white paper explains the differ- ences between metrics and KPIs; explains each of the KPIs; and offers insights into how analyzing and interpreting each KPI can shed light on a provider’s business. For example, the white paper shows how a high balance of 90+ A/R outside of normal collec- tions issues can suggest a lack of processes inter- nally to handle adjustments and write-offs.
“The KPIs shared in our new white paper are crit- ical to moving your company in the right direction because they offer a deeper understanding of your business and allow you to course-correct when you encounter red flags,” said Joey Graham, executive vice president and general manager for Prochant.
Providers can download the white paper for free by visiting www.prochant.com/home/ kpis-white-paper.
Attorney General William Barr and multiple law enforcement partners announced the largest coordinated sweep of elder fraud cases in history last month. The cases involved more than 260 defendants from around the globe, who allegedly targeted more than 2 million Americans in order to file phony Medicare cAlaims worth $1.7 billion.
joint federal crackdown has broken
up one of the largest healthcare fraud rings in U.S. history, involving tele- medicine companies, licensed medical
professionals, and 130 HME/DME businesses that allegedly bilked $1.2 billion out of Medicare through claims for fraudulent orthopedic brace prescriptions.
The scheme was investigated by the FBI and the Department of Health and Human Services Office of the Inspector General (HHS-OIG), and prose- cuted by the Department of Justice.
So far, 24 defendants associated with five tele- medicine companies, the owners of dozens of DME companies, and three licensed medical profes- sionals have been charged for their alleged partic- ipation in healthcare fraud. Also, the Center for Program Integrity at CMS has taken administrative action against 130 DME companies that allegedly billed Medicare for $1.7 billion in claims, which ulti- mately cost the Medicare program $1.2 billion. Of that, the DOJ reported the DMEs received $900
million in payment.
How the Scheme Worked
The fraud rotated around a scheme in which DME companies were paying kickbacks to telemarketing companies and lead generation firms after filing claims for back, shoulder, wrist and knee braces that were medically unnecessary, the DOJ reported.
The telemarketing firms would contact Medicare
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