You would think that the Centers for Medicare and Medicaid Services (CMS) and the Region C DME Regional Carrier (DMERC) would have realized that something was wrong when, almost overnight, 30% of the K0011 motorized wheelchair claims for the entire country started coming from Harris County, Texas. But they did not.

It was only after statistics for the entire year reached their desks that CMS officials took action. Now CMS Administrator Thomas A. Scully has launched a 10-point plan of attack (aka Operation Wheeler Dealer) on the entire industry because of the actions of a few thieves who took advantage of the system and its beneficiaries. Remember the fallout drill of the Cold War era? If not, learn it because the scorched earth plan announced by CMS on September 9 will soon be dropping ashes on your business.

Don’t get us wrong. CMS needs to take quick, decisive action against these scoundrels and any others that may come onto its radar screen. But it must be careful not to act so swiftly that it ends up hurting honest providers and needy beneficiaries.

More important, the industry must move beyond the stage of issuing press releases commending CMS for doing its job and become true partners in the war against Medicare fraud and abuse.

Providers should feel duty-bound to report any competitor they believe may be cutting corners or breaking the rules. Fear of reprisal is no excuse so long as you are abiding by the rules yourself. Fraudulent competitors are not just taking away your customers, they are threatening your livelihood!

Our trade associations need to beef up their codes of ethical practice and professional standards and then vigorously enforce them. Pledges of “zero tolerance” are meaningless if an organization cowers in a corner because some conservative lawyer suggests that “there might be antitrust issues.” It is time to kick butt and take names later. If a member is even suspected of a fraudulent act, the organization owes it to itself to conduct an investigation to determine whether members are violating ethical and professional standards. If that investigation turns up wrongdoing, the member should be expelled and reported to the antifraud unit. To do otherwise renders such “codes” meaningless.

Finally, accreditation agencies must revise their standards to include methods for detecting and/or preventing fraud and abuse. Again, a finding of wrongful billing to any payor must become grounds for immediate revocation of any accreditation. Mandatory accreditation is coming. Let’s get out in front for once and make it meaningful. Further, if the fraudulent acts can be traced back to an individual who is licensed or credentialed in any way, he or she should be banned from using those credentials for life.

A well-organized criminal enterprise has irreparably harmed the HME services industry. You may already be feeling the pain. If you were planning to open a new outlet this year, forget it. CMS Administrator Scully has effectively put a freeze on the issuance of new provider numbers. All claims for motorized wheelchairs are going to receive extra scrutiny resulting in inevitable delays in payment and an increased number of postpayment audits. Get used to it.

Things look bleaker down the road as the mushroom cloud expands. Scully’s plan includes the possible use of inherent reasonableness (IR) on motorized wheelchairs—specifically HCPCS K0011—the most inadequate and cumbersome code in the system. K0011 includes a diverse range of products from low-end scooter-like units to complex high-end motorized wheelchair bases. How do you fairly and accurately use IR on a code that covers products with retail prices from $3,600 to more than $7,000?

Perhaps the worst outcome of the scandal is the fact that many of the HME industry’s allies in Congress may reconsider their positions at the very time that critical votes will be taken that can profoundly and negatively affect the way you do business. There is only one way to combat the bad publicity coming out of Houston. It is for the industry to become actively, vocally, and visibly engaged in the war on fraud.

This is not a time for navel gazing or endless discussions. It is a time for immediate, decisive action! Scully has laid down his plan. The industry needs to respond to it by demonstrating that, even though it does not agree with all his points, it is ready to join him in the fight against fraud. Our concrete actions over the coming months will speak much louder than the words contained in pointless press releases.

Cara C. Bachenheimer, JD, is vice president of government relations for Invacare, Elyria, Ohio. David T. Williams is director of government relations for Invacare.