Medicare: Covert Testing Exposes Weaknesses in the Durable Medical Equipment Supplier Screening Process
DIANE Publishing, 2009 - 24 pages
Schemes to defraud the Medicare program have grown more elaborate in recent years. In particular, the Centers for Medicare and Medicaid Service┐s (CMS) oversight of suppliers of durable medical equip., prosthetics, orthotics, and supplies (DMEPOS) is inadequate to prevent fraud and abuse. Weaknesses in the DMEPOS enrollment and inspection process have allowed sham co. to fraudulently bill Medicare for unnecessary or nonexistent supplies. From 4/06 through 3/07, CMS estimated that Medicare improperly paid $1 billion for DMEPOS supplies -- in part due to fraud by suppliers. This report used publicly available guidance to attempt to create DMEPOS suppliers, obtain Medicare billing numbers, and complete electronic test billing. Charts and tables.
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25 standards application for billing application review approval letter Approval Process August 15 billing privileges CMS’s company’s complaint complete test billing compliance comprehensive liability insurance corrective action plan denied our applications DMEPOS Supplier Application DMEPOS wholesale supplier documentation durable medical equipment electronic billing electronic funds transfers enrollment application February 13 federal fill orders fraudulent company fraudulently billed Medicare HHS IG hours of operation identification information inspectors insurance policy inventory legitimate licenses maintain Maryland DMEPOS Supplier Maryland office Medicare beneficiary numbers Medicare billing number Medicare program Medicare Suppliers Medicare-covered item NSC requested NSC’s on-site inspections orders for equipment Orthotics owner passwords from CMS phone numbers physical facility physical office physician identification numbers posted hours Prosthetics purchased repair policy road tar sent NSC September 28 Standard 14 Standards for Medicare submit claims supplier contract supplier standards Suppliers of Durable test billing process undercover investigator Virginia DMEPOS Virginia office