|
The demonstration project is expected to begin in June
2012. This demonstration project was developed to deal with the
large amount of fraud that occurs in distribution of PMD's. As SMP
programs are well aware, Medicare loses a great deal of money every
year on PMD's that are billed for fraudulently (i.e., they were
never received by beneficiaries in the first place) and for PMD's
that are not medically necessary (i.e., a salesperson went
door-to-door in a senior building and gave everyone a 'free'
scooter).
Under the
project, the rules for approval of a PMD will remain the same
as they have always been: a PMD must be prescribed by a doctor
after a face-to-face visit; it must be needed for use inside
the person's home (if a scooter is only needed to get around
outside, this is NOT covered by Medicare!), and the medical
equipment (DME) company should have supporting documentation
from the person's doctor showing why the person needs a PMD. Before
delivering a PMD, the DME company should provide a 'fitting,' in
which the company ensures that the device will fit and work in the
person's home, as well as fit the person properly.
The only change
that will be made as a result of this demonstration project is that
doctors and DME companies will need to submit documentation to
Medicare showing the person's need for a scooter or power wheelchair
BEFORE submitting a claim. Medicare can then review the
documentation to ensure that the PMD is necessary before paying for
it.
[to top of second
column]
 |
 To learn more
about the new PMD demonstration project, visit the CMS website for
the project here:
http://www.cms.gov/CERT/03_PADemo.asp
We anticipate
that fraudulent DME companies may attempt to find ways to 'get
around' the rules of this new demonstration project. Therefore, we
want to remind everyone of two very important tips:
-
If
you believe that you may need a piece of medical equipment, call
your doctor first. Do not accept equipment, supplies, or other
services from anyone who calls on the phone or comes to your door!
-
Do
NOT sign contracts or forms without reading and fully understanding
what you are signing. Often, companies will require a person to sign a form that makes
them financially responsible for equipment if Medicare does not
pay. It is important to understand that this generally means that
you may be billed for the full cost of the equipment – do not sign
forms like this unless you intend to pay that full amount!
[Copy of
Illinois SMP Fraud Alert]
|
