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Medicare News
Fraudulent Medicare Practices by Medical Equipment
Suppliers Targeted by HHS
South Florida and Southern California are focus of
effort
July 10, 2007 - A two-year effort designed to
further protect Medicare beneficiaries from fraudulent suppliers of
durable medical equipment, prosthetics and orthotics supplies (DMEPOS)
was announced today by Mike Leavitt, Secretary of Health and Human
Services. The initiative is focused on preventing deceptive companies
from operating in South Florida and Southern California.
"Eliminating fraudulent suppliers in Medicare
protects America's seniors and enhances their quality of care,"
Secretary Leavitt said.
"This initiative is aimed at doing just that -
stopping durable medical equipment fraud before it happens."
Miami and Los Angeles have been identified as
high-risk areas when it comes to fraudulent billing by DMEPOS suppliers.
HHS, working with the Department of Justice (DOJ), formed a Medicare
Fraud Strike Force to combat fraud through the use of real-time analysis
of Medicare billing data. In just three months, 56 individuals have been
charged in the Southern District of Florida with fraudulently billing
Medicare for more than $258 million. The strike force is made up of
federal, state and local investigators.
The types of fraud committed by the DMEPOS
suppliers in South Florida and the Los Angeles metropolitan area
included:
(1) billing for services not rendered, which involved claims for power
wheelchairs, scooters, nutritional products (i.e., Ensure), orthotics,
prosthesis, hospital beds, etc., and
(2) billing for services not "medically necessary." The Centers for
Medicare and Medicaid Services and its contractors have identified
thousands of Medicare beneficiaries living in California and Florida who
are receiving DMEPOS items that they did not require based upon their
medical history and/or are receiving Medicare EOBs for items that are
not only unnecessary, but never ordered by their physician and never
received by the beneficiary.
CMS staff in Los Angeles and Miami has interviewed
multiple physicians who have provided attestations that they never saw
the patients for which DME was ordered and correspondingly never ordered
the suspect DME.
Last December federal officials contracted with the
National Supplier Clearinghouse to conduct visits to 1,472 South Florida
DMEPOS suppliers. Through on site investigations, 634 supplier billing
numbers were revoked, saving Medicare a projected $317 million.
Examples of products that are being billed at
higher than normal rates are motorized wheelchairs; nebulizers and
aerosol medications; artificial limbs; and wound therapy treatments. A
similar initiative happened in the Los Angeles area last year.
Investigations of 2,000 DMEPOS suppliers resulted in 770 having their
billing privileges revoked. Like South Florida, Los Angeles has been a
hotbed of fraudulent activity.
Under the initiative announced today, the Centers
for Medicare & Medicaid Services (CMS) will implement a demonstration
project requiring DMEPOS suppliers in South Florida and Southern
California to reapply for participation in Medicare in order to maintain
their billing privileges.
Letters will be sent out to suppliers asking that
they resubmit applications to be a qualified Medicare DMEPOS supplier.
Those who fail to reapply within 30 days of receiving a letter from CMS;
fail to report a change in ownership or address; or fail to report
having owners, partners, directors or managing employees who have
committed a felony within the past 10 years; will have their billing
privileges revoked.
"The concept is straight forward and will be
effective," CMS Acting Administrator Leslie Norwalk said. "Enhancing our
review of these suppliers will go a long way to ferret out those who do
not meet the needs of beneficiaries and the promises of Medicare. CMS
hopes to expand this effort nationwide."
Assistant Secretary for Aging Josefina G. Carbonell
added, "The financial independence and security of older people through
the identification and prevention of Medicare fraud is vitally
important. Senior Medicare Patrol volunteers across the country have
played and continue to play a crucial, frontline role in educating our
older Americans and their caregivers on how to avoid and, if necessary,
report suspected health care fraud."
HHS has several programs to help Medicare
beneficiaries protect themselves against fraud. The Senior Medicare
Patrol program, established by the Administration on Aging, educates and
assists beneficiaries in protecting their Medicare information,
detecting Medicare billing errors and reporting potential health care
fraud and abuse. Instances of potential Medicare fraud can be reported
to the HHS Office of the Inspector General at 1-800-HHS-TIPS
(800-447-8477) or
HHSTips@oig.hhs.gov. In addition, a fact sheet on this issue is
available at
www.hhs.gov/news/facts/medicarefraud/.
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