From: Florida Today

Sheldon Prial

Far too much money is being stolen from Medicare, which affects every recipient. These events are regularly reported in FLORIDA TODAY.

In Brevard County, there are many hard-working home medical equipment (HME) independent dealers who asked for a meeting with Congressman Bill Posey, R-Rockledge, to discuss this situation. During the meeting, they spoke about how part one of the competitive bid legislation failed, and what part two would create when it is activated. The threatened reimbursement reductions would force many dealers to close their doors.

Senior citizens, patients and their family caregivers were greatly affected by part one. They were unable to get their supplies and care from the local dealer who has been their source (and friend). A number said they had to do without because it was too difficult for them to seek products out of their neighborhood.

Reimbursements have to be based on quality not just price. There currently are no standards for products such as walkers, but these must be quality products. The difference between a Lumex or an offshore knock-off is tremendous. The reimbursement schedules should reflect not only the price but also stipulate quality. The cheaper units will not last long and often break down, injuring patients. Providers and dealers have to be reimbursed on standards and quality.

Fraud and abuse have created this monster. When a crook is arrested selling drugs, he goes to jail. But when he opens a durable medical equipment (DME) location and is found to be cheating, he will be closed. This is a lot better than being incarcerated.

Congressman Posey has joined forces with many peers preparing a new bill for fair pricing. The Market Pricing Program (MPP) bill will help bring down the costs for Medicare.

MPP includes the same DME as in the competitive bid program. These new rates in MPP are consistent with Congress’ intent to allow beneficiaries access to quality and service.

The MPP bid areas are smaller than the current large metropolitan areas. It includes all the same items now in the bidding program. Unlike the flawed auction system of the current competitive bidding scheme, the bids for the MPP program will be binding and cash deposits from the bidders will be required. The contract awards will be based on the clearance price, not the median price of winners.

This will be a win-win situation for all but essentially for the recipients, the dealers and the Centers for Medicare and Medicaid Services. They will reimburse only for the supplies provided, not for fraud and abuse.