Efforts To Reduce Medicare Fraud In States

Ruzanna Harutyunyan's picture

CMS on Monday announced new efforts to detect and combat Medicare fraud committed by durable medical equipment suppliers and home health care agencies, CongressDaily reports. Under the plan, the agency will expand a recovery audit contractor program nationwide. The program ran as a three-year demonstration project in six states and recovered $900 million in overpayments (Edney, CongressDaily, 10/6). Contractors will focus on companies and individuals whose Medicare billings are higher than those submitted by the majority of providers and suppliers in a community. The contractors will be compensated based on the overpayments and underpayments they identify (Carey, CQ HealthBeat, 10/6).

CMS will pay particularly close attention to DME suppliers in California, Florida, Illinois, Michigan, New York, North Carolina and Texas. DME suppliers in those states will be subject to more thorough examination of claims, and CMS will make unannounced visits to ensure the companies are in business (CongressDaily, 10/6). In addition, the agency will conduct more in-depth background checks of DME suppliers, as well as more interviews with beneficiaries to see whether they received supplies and whether they were qualified to receive benefits.


CMS also announced that it will take targeted steps to combat fraud by home health care agencies in Florida who claim to provide services for sicker-than-average beneficiaries and receive special additional payments. Those payments represented 60% of all home care bills paid by Medicare in Miami last year, compared with the national average of 6%. CMS acting Administrator Kerry Weems announced the suspension of payments to the 10 Miami-area home health care agencies that receive most of these payments, pending an investigation.

Weems said, "There are many reputable, caring durable medical suppliers who do a very good job. But then there are also some that are, frankly, rotten" (Appleby, USA Today, 10/7). He added, "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" (CongressDaily, 10/6). Walter Gorski -- vice president of government affairs for the American Association of Homecare, which represents DME suppliers -- said the organization agrees with many of CMS' plans. "A lot of what they're saying is what they should be doing already," Gorski said (USA Today, 10/7).

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