Medicare Paid Out $900 million In False DME Claims

Medicare Paid Out $900 million In False DME Claims

Large fraudulent medical billing claims are making the senate the Government Accountability Office antsy. Charles Grassley recently sent a letter to the Centers for Medicare & Medicaid Services with a daunting reality. CMS wasted $900 million dollars in incorrect durable medical equipment in 2004. For the survival of Medicare something has to change. This fraudulent medical billing needs to be taken care of.

Apparently the 2004 incorrect medical billing dealt with orthotics, equipment, and prosthetics. It seems that the Centers for Medicare & Medicaid services did not keep a closer eye on their National Supplier Clearinghouse. This contractor’s job was to check that all of the Medicare suppliers were compliant with the 21 standards set forth. Unfortunately, Grassley found that the clearing house relied heavily on self evaluations and did far too few on-site inspections. It is no wonder medical billing has gotten out of control. Monitoring was not sufficient.

To correct these medical billing mistakes and reimbursement errors, Charles Grassley made five requests. Each of these requests must be received by October 31, 2005. The first request is an explanation of Medicare’s policy for ridding of fraudulent medical billing suppliers. Second, he would like a list of all suppliers being investigated from the years 2003 and 2005. This is only for some states. He also wants a written plan for signing quality suppliers. This way medical billing mistakes will not happen in the future. Grassley also requested copies of the National Supplier Clearinghouse evaluation and an investigation on whether or not they have met their end of the contract.

Don’t be surprised if your durable medical equipment supplier has an on-site evaluation. This does not necessarily mean that you have questionable medical billing practices. It just means that CMS needs to crack down on everyone’s medical billing so they can save millions of dollars.

View all Articles by: Melissa Clark, CCS-P