03/08/2024

AAHomecare Supports Anti-Fraud Measures in Wake of Intermittent Catheter Criminal Activity; Ohio Department of Insurance Releases Consumer Alert

Last month, news organizations published articles regarding potential Medicare fraud schemes by a handful of intermittent catheter companies that were presented to the federal government by the National Association of Accountable Care Organizations. 

The American Association for Homecare responded by releasing a statement to CMS and Capitol Hill offices affirming its support for the ability of the federal government to implement real-time monitoring of submitted claims to detect potentially aberrant or abusive behavior.   In this week’s AAHomecare Insider (second article), the organization notes that they are “appalled at the level of fraud that occurred from what appears to be outright criminal elements that preyed on Medicare’s vulnerabilities using the catheter benefit”.  

OAMES has also learned that the Ohio Department of Insurance (ODI) issued a Consumer Alert related to this activity titled “Ohioans Cautioned to Watch for Medicare and Medical Supplies Scam”.  The Alert warns consumers to watch for the following red flags:

• You don't recognize the ordering physician’s name, nor have you been seen by the physician.
• The ordering physician is located in another state.
• You receive an Explanation of Benefits document or Medicare Summary Notice document with a large quantity of supplies you have never received.
• You don't have a medical condition that would require the supplies. 

ODI offers resources and assistance for any Ohioans affected by the scam.  See details and contact information in the Alert here.