"We have consistently found that Medicare enrollment standards and oversight are not sufficient to prevent noncompliant and sham suppliers from obtaining Medicare provider numbers and billing privileges. Some Medicare-enrolled suppliers fail to maintain even the most basic Medicare standards - for example, maintaining a physical facility, or being open during reasonable business hours," Levinson said.

Levinson went on to say that the OIG had reviewed payments over the past two decades and has determined that for certain items, the program pays too much - such as for power wheelchairs and oxygen equipment. Levinson said compliance programs and education can assist in appropriate billing, and vigilant monitoring through data analysis and claims review should be initiated. The competitive bidding program can also address the vulnerabilities identified by OIG, Levinson said, by "better aligning reimbursement for these items with market prices."


"It also includes important enrollment safeguards, such as licensure requirements, and provides a mechanism for ensuring that CMS has better information about the suppliers when granting billing privileges," he added. "[I]t may facilitate oversight efforts by limiting the pool of providers to only those who have been approved through the competitive bidding process and pass rigorous enrollment standards."

However, Karen A. Lerner, Wound Care, Support Surface & Rehab Specialist for Allcare Medical, of Sayreville, N.J., said in her testimony that she was concerned about what would happen to patients if competitive bidding becomes reality.

Lerner said that she felt competitive bidding was not true competition but in fact anti-competitive. Using support surfaces as an example, she explained that providers would have to furnish the least expensive product or lose money on a support surface order. Then, if every patient who needed that particular product was placed on the least expensive support surface, "most of those patients' pressure ulcers would worsen and they would end up in the emergency department or be admitted to hospitals for surgical débridement. I see patients on inferior support surfaces and improper low-end wheelchair cushions get re-admitted to hospitals for pressure ulcers every day."

Competitive bidding would stop the clinician and patient from having a choice, Lerner said, and costs will ultimately be shifted from Medicare Part B to Part A, with patient care compromised and negative outcomes as a result.

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