In Response to CRUSH Initiative, CQRC Offers Concrete Solutions to Preserve Program Integrity and Protect Patient Access

The CQRC submitted comments to CMS’s Comprehensive Regulations to Uncover Suspicious Healthcare (CRUSH) initiative, proposing opportunities to eliminate fraud and waste

WASHINGTON – The Council for Quality Respiratory Care (CQRC) submitted formal comments in response to the Centers for Medicare & Medicaid Services’ (CMS) Request for Information (RFI) on the Comprehensive Regulations to Uncover Suspicious Healthcare (CRUSH) initiative, offering targeted, practical solutions to eliminate fraud, waste, and abuse while maintaining access to essential patient care services.

CQRC’s response acknowledges the significance of the Administration’s effort to strengthen the integrity of federal healthcare programs and emphasizes the importance of rooting out illegitimate actors while enhancing oversight and accountability in these programs. The CQRC comments included clear, actionable solutions to protect Medicare beneficiaries and ensure compliance for respiratory care suppliers and providers, including: 

• Eliminating payment incentives that enable fraud and abuse by holding Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) suppliers accountable to the prices they bid through the Medicare Competitive Bidding Program.
• Reestablishing comprehensive supplier financial documentation qualification requirements to ensure participating suppliers meet high-quality criteria.
• Empowering beneficiaries with stronger patient protections, including providing patients with clear, up-to-date information about their cost-sharing responsibilities.
• Increasing transparency in the audit and appeals process by requiring CMS to release annual reports detailing audit activity, including the number of appeals and reasons for overturning denials. 

The CQRC letter also included recommendations for leveraging existing technology-based solutions, including adopting a standardized documentation template in place of extensive medical records to help advance CMS’s key objective to prevent fraudulent or abusive claims by requiring Medicare contractors to adopt electronic data elements that CMS has already created. This would not only help prevent fraudulent billing, ensure clear clinical verification standards, and reduce administrative workload, but also provide much-needed clarity and accuracy in the review process.

“By having prescribers submit the standardized data elements electronically, which could be part of an ePrescribing platform, CMS and its contractors would receive the information necessary to establish medical necessity in an electronic format that would increase their ability to promote payment accuracy and efficiency,” the letter states. “These data elements would not only provide clear direction to physicians who prescribe supplemental oxygen, but they also would make the medical review process efficient, accurate, and less costly.”

The CQRC recommendations aim to ensure claims are legitimate and medically necessary and strengthen system-wide transparency for providers, patients, and federal program leaders. “We encourage CMS to take this common-sense step and require the contractors to use the clinical data element template in lieu of medical records. Taking this approach would then allow the contractors and CMS to target their resources on actual fraud and abuse to protect taxpayer dollars,” the letter reads. 

Many solutions recommended by the CQRC are included in the bipartisan Supplemental Oxygen Access Reform (SOAR) Act (S.1406/H.R.2902), supported by patient, physicians, and provider groups, which would address quality reforms and fraud prevention without restricting access to necessary oxygen care for beneficiaries with complex respiratory and health needs. 

“We encourage CMS to review the provisions of the SOAR Act that would strengthen current laws to prevent fraud and abuse, promote Medicare program integrity, and protect beneficiaries if the legislation were enacted,” CQRC Chair Robin Menchen states in the letter. “We are committed to eliminating fraud and abuse so that legitimate suppliers can provide medically necessary services to beneficiaries in the care setting that is the most appropriate for them – their home.”

To read the CQRC’s full comments in response to the CRUSH initiative RFI, click here. 

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The Council for Quality Respiratory Care (CQRC) is a coalition of the nation’s leading home oxygen therapy providers and manufacturing companies providing in-home patient services and respiratory equipment including liquid oxygen, oxygen concentrators, and sleep therapy devices to Medicare beneficiaries who rely upon home oxygen therapy to maintain their independence and enhance their quality of life. Learn more at cqrc.org.