Agency beefs up Medicare fraud detection efforts
Officials announce the launch of a recovery audit contractor program that will track businesses with high billing.
The Centers for Medicare and Medicaid Services announced Monday it is ramping up efforts to detect fraud that costs the agency millions in fake billing for home health services and durable medical equipment never delivered.
CMS officials said the agency is launching a national recovery audit contractor program that will track businesses whose billing for Medicare services trends higher.
CMS also is taking additional steps in specific states where fraud is the most rampant.
"Because Medicare pays for medical services and items without looking behind every claim, the potential for waste, fraud and abuse is high," CMS Acting Administrator Kerry Weems said in a statement. "By enhancing our oversight efforts we can better ensure that Medicare dollars are being used to pay for equipment or services that beneficiaries actually received while protecting them and the Medicare trust fund from unscrupulous providers and suppliers."
Durable medical equipment suppliers, who provide such equipment as oxygen supplies or power wheelchairs, have faced increasing heat as lawmakers search for areas of Medicare's budget to trim and Senate Republicans make fighting Medicare fraud their major healthcare focus.
CMS estimates that $1 billion of the $10 billion it made in payments for durable medical equipment from April 2006 to March 2007 were improper, in part due to fraud, according to a recent GAO report. Both the Government Accountability Office and the Health and Human Services inspector general have urged CMS to beef up its fraud detection efforts on the equipment industry. Durable medical equipment suppliers, represented by the American Association of Homecare, agree with CMS' announcement Monday, a spokesman said.
During a three-year demonstration program in six states, the recovery audit contractors that CMS now plans to use nationwide recovered $900 million in overpayments. The agency also plans to verify with beneficiaries delivery of home health services or durable medical equipment for which Medicare was billed and keep an even closer eye on durable medical equipment suppliers in Florida, California, Texas, Illinois, Michigan, North Carolina and New York as well as home health agencies in Florida.
In those states, equipment suppliers' claims will be scrutinized more closely, and CMS will make unannounced visits to ensure the companies are in business.