With all the DME fraud and abuse, who can blame
the Feds for kicking back with more audits?
However, they have kicked the ball way too far
to the other side of the court.
It appears to many of my colleagues (and I would
agree) that there are far too many ill-trained
auditors who seem to be ignoring the materials
put in front of them. One can't blame those
providers who don't dot every "i" or
crossing every "t" from being frustrated.
This problem is not unique to podiatry and it
has been duly noted by other DME professionals
including but not limited to those in the
Orthotics and Prosthetics, oxygen suppliers
industry. When honest intelligent people fail
at greater than the 90% level on pre and post
payment audits one needn't wonder where the
problem is.
Even if one were to subtract the estimated 20%
to 30% of non responders to these audits as
being the chief cause of the problem
(the likelihood is that non responders are the
cheaters-in the vast majority of cases) this
would still leave an excess of 60% who would
fail an audit.
It's amazing that podiatrists who have on many
occasions been one of the professions having the
lowest failure rate for failing Part B Medicare
audits (this is GOOD) can be lumped into a 90%
failure rate withe DME. How can our
documentation be so good on the Part B side and
so poor with DME?
The latter of course has not been proven to me,
as no podiatry specific data has been provided
to me on claims or pre and post payment audits
for years. It's not for the lack of trying, it's
because we've been told it's simply not
available.
Many are quick to criticize the leadership of
our profession for failing to effectively
respond to Medicare. It would be impossible to
cite the many communications (both verbal and
written) which I have witnessed. The same can be
true for other organizations representing honest
professionals in the O&P industry as well.
The only way to fight back is to properly
document your work in accordance with the
regulations which while sometimes onerous are
required. Ultimately, those who provide the
proper documentation are overwhelmingly rewarded
upon appeal.
Paul Kesselman, DPM, Woodside, NY,
drkesselmandpm1@hotmail.com
