Medicare: More Effective Screening and Stronger Enrollment Standards Needed for Medical Equipment
DIANE Publishing, 2006 - 51 pages
In FY 2004, the Centers for Medicare & Medicaid Services (CMS) est. that Medicare improperly paid $900 million for durable med. equip., prosthetics, orthotics, & supplies -- in part due to fraud by suppliers. To deter such fraud, CMS contracts with the NCS to verify that suppliers meet 21 standards before they can bill Medicare. NSC verifies adherence to the standards through on-site inspections & document reviews. Recent prosecutions of fraudulent suppliers suggest that there may be weaknesses in NSC's efforts to screen suppliers or in the standards. This report evaluated: NSC's efforts to verify suppliers' compliance with the 21 standards; the adequacy of the standards to screen suppliers; & CMS's oversight of NSC's efforts. Charts & tables.
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applications bill Medicare billed for oxygen billing number billing privileges claims CMS Response CMS's oversight companies comprehensive liability insurance conducting on-site inspections contractor custom-fabricated orthotics Desk review directory assistance DME regional carrier DMEPOS items DMEPOS suppliers documentation durable medical equipment efforts to verify enroll suppliers enrollment and reenrollment ensure federal contracts fiscal year 2004 fraud Government Accountability Office inspection form inspector interviews integrity and capability interviews the owner investigation licenses licensure locations Medicaid Medicare Prescription Drug Medicare program Medicare suppliers Medicare's 21 Standards Medicare's standards million minimum number NSC verifies NSC's active NSC's efforts NSC's performance NSC's Procedures out-of-cycle on-site inspections physical facility power wheelchairs Procedures to Verify proof of delivery Region C DME require NSC require suppliers required on-site inspections Response We concur responsible employee reviewing beneficiary files SACU site inspection form source of inventory Standards for Suppliers supplier standards suppliers billing verify compliance verify suppliers
Page 24 - Have the necessary organization, experience, accounting and operational controls, and technical skills, or the ability to obtain them...
Page 35 - GAO's Web site at http://www.gao.gov. If you or your staff have any questions about this report, please contact me at (312) 220-7600 or firstname.lastname@example.org.
Page 1 - Medicare law defines orthotic devices to include leg, arm, back, and neck braces that provide rigid or semirigid support to weak or deformed body parts or restrict or eliminate motion in a diseased or injured part of the body. Medicare-reimbursed DME supplies are items that are used in conjunction with DME and are consumed during the use of the...
Page 1 - Medicare 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. DME includes items such as wheelchairs, hospital beds, and walkers. Medicare defines prosthetic devices (other than dental) as devices that are needed to replace a body part or function. Prosthetic devices include artificial limbs and eyes and cardiac pacemakers. Medicare defines...
Page 37 - We determined that these data were sufficiently reliable for the purposes of this report. We...
Page 1 - ... contain copyrighted images or other material, permission from the copyright holder may be necessary if you wish to reproduce this material separately.
Page 1 - ... disabled beneficiaries. One of the responsibilities of the Centers for Medicare & Medicaid Services (CMS), the federal agency that administers Medicare, is to provide beneficiaries and other members of the public with clear, accurate, and timely information about the program.
Page 2 - NSC's efforts to verify compliance with the standards or in the standards 'According to the Department of Health and Human Services Office of Inspector General that investigates alleged DMEPOS and other fraud, from 2003-2004, nine criminal cases involving DMEPOS supplier fraud have gone to trial. As of February 4, 2005, 21 individuals involved in such cases have been convicted of fraud, and over $70 million in improper payments has been recovered.