Fraud Making Medicare Situation Worse

We all keep hearing about the problems with the Medicare system including mistakes and underbilling, overbilling and the like.  We also hear about fraudulent claims, but things are a lot worse than we have been aware of, and it is costing billions of dollars that could be going toward benefits rather than cuts.  The government has been authorizing reimbursements to fraudulent companies for wheelchairs and other equipment, and these reimbursements have cost over a billion dollars.  Most of these payments have been made to fake doctors and fake medical supply companies. In fact, the Government Accountability Office (GAO) has been investigating the Centers for Medicare Services (CMS) over the past year and found that CMS had granted billing privileges to two phony companies based in Maryland and Virginia who were supposed to be suppliers of equipment for Medicare recipients, but had no supplies whatsoever to provide to these individuals.   In setting up this investigation, the GAO provided CMS with false and sketchy information, and CMS still provided them with the ability to bill for services.  This put the fake companies into a situation where not only could they bill for millions of dollars, but they could have also gotten a doctors’ identification code fraudulently and started submitting claims, costing CMS even more money in payments.  This “sting” by the GAO proves that there are issues with the enrollment process for Medicare suppliers and that there need to be changes so that fraudulent suppliers don’t take advantage of these issues and loopholes.  As a result, the GAO has recently made some changes in enrollment procedures including the requirement that suppliers must be certified and meet other quality standards before they are allowed to do any billing. In addition, some other changes include making it mandatory for suppliers to keep all paperwork from doctors, limiting the use of pagers and cell phones as primary contact numbers for suppliers, and setting up new competitive bidding procedures for suppliers of medical equipment.  CMS has been promising since 2005 that they would eliminate much of the fraud in the system, especially in approving fraudulent suppliers.  This latest study by the GAO shows that there are still too many problems costing the system, the taxpayers and Medicare recipients too much, with the potential to cost them even more.  Had there been real companies behind this sting, rather than fake companies, it could have cost many more millions of dollars. With Medicare benefits in jeopardy of continuing to be cut, it is time to make sure that CMS is doing its job rather than giving money that is already too scarce away.  Perhaps if that happened, cuts would not be necessary and Medicare recipients could receive the benefits that they truly need.

Filed under: General-Medicare

Tags: General-Medicare, medicare benefits, Medicare biling, medicare fraud, Medicare reimbursements