Medicare: Covert Testing Exposes Weaknesses in the Durable Medical Equipment Supplier Screening Process

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DIANE Publishing, 2009 - 24 pages
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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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