Page 14 - HME Business, October 2019

A Game Plan for Six-Year Lookbacks
CMS’s six-year lookback audits represent a daunting challenge for HME providers, but there are steps they can take to deal with them.
BTy Holly J. Wagner
he word “audit” can strike terror into the heart of any business owner, especially if you don’t know what to expect or how to prepare and respond. An audit that goes back six years sounds like terror x 6,
but it may not have to be.
A DME business that’s been following all the
rules and has been stringent about getting documentation for every prescription in advance will have little to worry about from the new six-year lookback rule — but will still have to respond. Just like the Internal Revenue Service, your DME MAC won’t forget about you if you just keep your head down.
“What will happen if the DME supplier says, ‘I’m not going to mess with it,’ is the DME MAC will come in and do their own audit, then you have false claims liability,” says attorney Jeffrey S. Baird, Esq., is chairman of the Health Care Group at law firm Brown & Fortunato, P.C. “That could be far more expensive than complying: “The civil liability under the False Claims Act (FCA) is actual damages, plus treble damages, plus up to approximately $21,000 per claim.”
You can’t blame CMS for checking. According to the most recent Comprehensive Error Rate Testing (CERT) data available, fiscal year 2017, Medicare fee-for-service programs overall
have an 8.12 percent overpayment rate, but for DMEPOS it jumps up to 35.54 percent, and that adds up to $2.59 billion.
For now, DMEs that have the most cause for concern are those who have a large PAP busi- ness. But that doesn’t mean DMEs are in the clear on other products; this was just the first review to trigger a major clawback. Any segment that requires refills or monthly supplies will be susceptible to problems, and some practices that may have been acceptable (or just gone unnoticed) in the past, like blanket orders, won’t fly now.
“What has happened here can be replicated for other kinds of supplies,” Baird says. Diabetic,
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