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Medicare
spending billions of dollars on questionable
claims for Medical Equipment, report finds
[Sep 24, 2008]
CMS
in recent years has paid more than $1
billion in questionable Medicare claims for
medical equipment with minimal or no
relation to the conditions of beneficiaries,
according to a report released on Wednesday
by the
Senate
Permanent Subcommittee on Investigations,
USA Today reports.
The report marked the third in a
series
released by the subcommittee on questionable
Medicare claims.
For the report, investigators reviewed Medicare claims
submitted by medical equipment suppliers
from January 2001 to December 2006 for 18
items (Appleby, USA Today,
9/24).
According to the report, CMS reviewers in
many cases failed to ensure that Medicare
claims for medical equipment included a
valid diagnosis code (Anderson,
Minneapolis
Star
Tribune, 9/23). The
practice leaves "billions of taxpayers'
money susceptible to fraud, waste and
abuse," the report said.
CMS has required the use of diagnosis codes on Medicare
claims from medical equipment suppliers
since 2003.
After 2003, the number of Medicare claims for medical
equipment paid by CMS that included invalid
diagnosis codes significantly decreased but
exceeded $23 million between 2004 and 2006,
the report found.
Investigators did not determine the number of Medicare
claims for medical equipment paid by CMS
that included valid but questionable
diagnosis codes after 2003 except for blood
glucose test strips.
The number of Medicare claims for blood glucose test strips
paid by CMS that included questionable
diagnosis codes did not decrease after 2003,
according to the report.
CMS spokesperson Peter Ashkenaz said, "CMS
has always used clinical information,
including diagnosis codes, to target certain
vulnerable and high-risk claims.
Since 2003, CMS has validated diagnosis codes on all
(durable medical equipment) claims" (USA Today, 9/24).
Subcommittee ranking member Sen. Norm
Coleman (R-Minn.) said, "Since when did
doctors start prescribing blood glucose test
strips for the bubonic plague?" adding,
"CMS' review process simply doesn't check to
see whether the claim makes sense, and that
leaves Medicare vulnerable to fraud, waste
and abuse. Bottom line: We need to know
where our Medicare dollars are going" (Yen,
AP/St. Paul Pioneer Press,
9/23).
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