HME News: Audits: Stakeholders strike while iron is hot

Expect the outcry over audits to heat up in the coming weeks, say HME industry stakeholders.

The Office of Medicare Hearings and Appeals (OMHA) plans to hold a daylong forum Feb. 12 to discuss a massive backlog of appeals that has forced it to suspend the assignment of new cases to the administrative law judges (ALJs) for as long as two years. Chief ALJ Nancy Griswold detailed the dire situation in a Dec. 31 memo to providers who currently have appeals pending.

“I think the memo was an attempt by the judge to showcase that they don’t have the manpower,” said John Gallagher, vice president of government affairs for The VGM Group. “They are throwing up a huge red flag to cease and desist.”

Gallagher plans to strike while the iron is hot, meeting with lawmakers the day after the forum, on Feb. 13. VGM is urging providers to join him.

Stakeholders aren’t the only ones crying foul. The American Coalition for Healthcare Claims Integrity on Jan. 21 issued a response to Griswold’s memo, accusing the ALJ of “jamming up the auditing process and undermining the RAC program overall.”

With audits affecting such a wide swath of health care—not just HME providers—stakeholders are reaching out across the aisle to home health agencies and hospital groups.

“We plan to draft a letter to CMS reiterating what all the associations are saying,” said Kim Brummett, director of regulatory affairs for AAHomecare.

But getting everyone on the same page may be a challenge, stakeholders acknowledges.

“Because the healthcare system is so fractionalized, we rarely ever find out what someone else wants to do or is considering doing until it is done,” said Edward Vishnevetsky, an attorney with Munsch Hardt. “We still need to go at this and contact others.”

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Theresa Flaherty