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Acting CMS Administrator Weems announces
efforts to reduce Medicare Fraud in seven
states
[Oct 07, 2008]
CMS
on Monday announced new efforts to detect
and combat Medicare fraud committed by
durable medical equipment suppliers and home
health care agencies,
CongressDaily
reports.
Under the plan, the agency will expand a
recovery audit contractor program
nationwide. The program ran as a three-year
demonstration project in six states and
recovered
$900 million in overpayments (Edney,
CongressDaily,
10/6).
Contractors will focus on companies and
individuals whose Medicare billings are
higher than those submitted by the majority
of providers and suppliers in a community.
The contractors will be compensated based on
the overpayments and underpayments they
identify (Carey,
CQ HealthBeat,
10/6).
CMS will pay particularly close attention to
DME suppliers in California, Florida,
Illinois, Michigan, New York, North Carolina
and Texas.
DME suppliers in those states will be
subject to more thorough examination of
claims, and CMS will make unannounced visits
to ensure the companies are in business (CongressDaily,
10/6).
In
addition, the agency will conduct more
in-depth background checks of DME suppliers,
as well as more interviews with
beneficiaries to see whether they received
supplies and whether they were qualified to
receive benefits.
CMS also announced that it will take
targeted steps to combat fraud by home
health care agencies in Florida who claim to
provide services for sicker-than-average
beneficiaries and receive special additional
payments.
Those payments represented 60% of all home
care bills paid by Medicare in Miami last
year, compared with the national average of
6%. CMS acting Administrator Kerry Weems
announced the suspension of payments to the
10 Miami-area home health care agencies that
receive most of these payments, pending an
investigation.
Weems said, "There are many reputable,
caring durable medical suppliers who do a
very good job. But then there are also some
that are, frankly, rotten" (Appleby,
USA Today,
10/7).
He added, "By enhancing our oversight
efforts we can better ensure that Medicare
dollars are being used to pay for equipment
or services that beneficiaries actually
received while protecting them and the
Medicare trust fund from unscrupulous
providers and suppliers" (CongressDaily,
10/6).
Walter Gorski -- vice president of
government affairs for the
American
Association of Homecare,
which represents DME suppliers -- said the
organization agrees with many of CMS' plans.
"A lot of what they're saying is what they
should be doing already," Gorski said (USA
Today, 10/7).
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