Medicare: Improvements Needed to Address Improper Payments for Medical Equipment and Supplies

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DIANE Publishing, 2007 - 29 pages
The Centers for Medicare & Medicaid Services (CMS) -- the agency that administers Medicare -- estimated that the program made about $700 million in improper payments for durable medical equipment, prosthetics, orthotics, & supplies (DMEPOS) from April 1, 2005, through March 31, 2006. To protect Medicare from improper DMEPOS payments, CMS relies on 3 Program Safeguard Contractors (PSC), & 4 contractors that process Medicare claims, to conduct critical program integrity activities. This report examines CMS¿s & CMS¿ contractors¿ activities to prevent & minimize improper payments for DMEPOS, & describe CMS¿s oversight of PSC program integrity activities. Includes GAO recommendations. Charts & tables.

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Page 20 - We will also make copies available to others on request. In addition, the report will be available at no charge on GAO's Web site at If you or your staffs have any questions about this report, please contact me at (202) 512-7101 or
Page 1 - Medicare law defines durable medical equipment (DME) as equipment that serves a medical purpose, can withstand repeated use, is generally not useful in the absence of an illness or injury, and is appropriate for use in the home.
Page 4 - Department of Health and Human Services (HHS) Office of Inspector General (OIG), which oversees MFCUs at the federal level.
Page 6 - Medicare is the federal program that helps pay for a variety of health care services and items on behalf of almost 42 million elderly and certain disabled beneficiaries.
Page 1 - Both result in unnecessary costs to the insurer; but fraud generally involves a willful act, whereas abuse typically involves actions that are inconsistent with acceptable business and medical practices. As a practical matter, whether and how a wrongful act is addressed can depend on the size of the financial loss incurred and the quality of the evidence establishing intent. For example, small claims are generally not pursued as fraud because of the cost involved in investigation and prosecution....
Page 4 - I contains a more detailed discussion of our scope and methodology.) We performed our work between December 2000 and December 2001 in accordance with generally accepted government auditing standards. 2 Hereinafter, the term "states" will refer collectively to the 50 states plus the District of Columbia and Puerto Rico.
Page 29 - August 17, 2005. Health Care Fraud and Abuse Control Program: Results of Review of Annual Reports for Fiscal Years 2002 and 2003. GAO-05-134. Washington, DC: April 29, 2005. High-Risk Series: An Update. GAO-05-207. Washington, BC: January 2005.
Page 26 - Thank you for the opportunity to review and comment on the subject draft report.
Page 6 - B insurance," which helps pay for certain physician, outpatient hospital, laboratory, and other services; DME, such as oxygen, wheelchairs, hospital beds, and walkers; prosthetics and orthotics; and certain supplies.

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