Many lawmakers are outraged after allegations surfaced that the Centers
for Medicare & Medicaid Services misled Congress into thinking it
had significantly reduced the number of fraudulent claims for durable
medical equipment (DME).
In 2006, CMS claimed it had prevented billions of dollars in fraudulent
claims from being processed, and reduced the cost of DME fraud to $700
million. But according to a report in The New York Times this week,
these claims are inaccurate and improper spending on fraudulent claims
totaled about $2.8 billion. The Times cited a confidential draft of a
federal inspector general's report as proof of the allegations. Sen.
Charles Grassley (R-IA) has called the situation "outrageous." Rep.
Pete Stark (D-CA) told the Times he isn't surprised by the
irregularities, calling CMS an incompetent agency.
Meanwhile, CMS reportedly is preparing to implement its competitive
bidding program for durable medical equipment, prosthetics and
orthotics suppliers (DMEPOS). The program originally was scheduled to
begin on July 1 of this year, but recently was delayed by Congress for
18 months and will not begin until 2010. The competitive bidding
program, CMS hopes, will reduce DME costs to Medicare and, at the same
time, reduce fraudulent payments. Some opponents of the program have
argued that smaller businesses will not be able to compete with larger
DME suppliers for contracts.
for Medicare & Medicaid Services misled Congress into thinking it
had significantly reduced the number of fraudulent claims for durable
medical equipment (DME).
In 2006, CMS claimed it had prevented billions of dollars in fraudulent
claims from being processed, and reduced the cost of DME fraud to $700
million. But according to a report in The New York Times this week,
these claims are inaccurate and improper spending on fraudulent claims
totaled about $2.8 billion. The Times cited a confidential draft of a
federal inspector general's report as proof of the allegations. Sen.
Charles Grassley (R-IA) has called the situation "outrageous." Rep.
Pete Stark (D-CA) told the Times he isn't surprised by the
irregularities, calling CMS an incompetent agency.
Meanwhile, CMS reportedly is preparing to implement its competitive
bidding program for durable medical equipment, prosthetics and
orthotics suppliers (DMEPOS). The program originally was scheduled to
begin on July 1 of this year, but recently was delayed by Congress for
18 months and will not begin until 2010. The competitive bidding
program, CMS hopes, will reduce DME costs to Medicare and, at the same
time, reduce fraudulent payments. Some opponents of the program have
argued that smaller businesses will not be able to compete with larger
DME suppliers for contracts.
1 comment:
To correct one piece of your post, the competitive bidding program is a price-setting mechanism. The anti-fraud part of the same law (Medicare Modernization Act of 2003) relates to accreditation of home medical equipment providers (or durable medical equipment providers) who provide oxygen therapy and other services and equipment to beneficiaries. On July 15, 2008, Congress actually strengthened the fraud-prevention (accreditation) requirements by passing the Medicare Improvements for Patients and Providers Act. So to be clear, you need to make a distinction between the badly implemented competitive bidding program and the separate fraud-prevention efforts in the accrediation requirements for providers. The home medical equipment industry has advocated for accreditation and stronger anti-fraud measures generally for decades now. Some would have you believe that because the industry opposed the badly run bidding program it also opposes fraud prevention. Nothing could be futher from the truth.
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