US Government Clamps Down On Fraudulent Medical Equipment Suppliers

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Main Category: Medicare / Medicaid / SCHIP
Also Included In: Medical Devices;  Seniors / Aging
Article Date: 03 Jul 2007 - 0:00 PDT

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The US Department of Health and Human Services (HHS) announced yesterday that it was launching a two-year project to clamp down on suppliers of durable medical equipment such as wheelchairs, nebulizers and prosthetics who defraud Medicare beneficiaries.

The initiative will focus on South Florida and Southern California. Miami and Los Angeles have been identified as a hot bed of fraudulent suppliers of what is termed durable medical equipment, prosthetics and orthotics supplies (DMEPOS).

A Medicare Fraud Strike Force made up of federal, state and local investigators, from a collaboration between the HHS and the Department of Justice (DOJ) are analysing Medicare bills as they come in.

In just three months, in the Southern District of Florida, over 50 people have been charged with fraudulently billing Medicare of more than 258 million dollars.

"Eliminating fraudulent suppliers in Medicare protects America's seniors and enhances their quality of care," said HHS Secretary Mike Leavitt.

"This initiative is aimed at doing just that: stopping durable medical equipment fraud before it happens," he added.

Investigators found one case where a medical equipment supplier had falsely obtained over 2 million dollars for repeatedly billing for the same wheelchair.

In another case investigators went to the supplier's address and found an empty office.

Last year, visits to nearly 1,500 DMEPOS suppliers in South Florida and 2,000 in Los Angeles resulted in nearly a third of them having their licences revoked. The 634 fraudulent suppliers in South Florida were overcharging Medicare a total of 317 million dollars for products like motorized wheelchairs, nebulizers, aerosol equipment, artificial limbs and wound therapy treatment.

In future, DMEPOS suppliers in South Florida and Southern California will have to reapply for their Medicare licences under a new more proactive and rigorous pilot system which the Centers for Medicare and Medicaid Services (CMS) hope will eventually be rolled out nationwide.

Suppliers will be contacted by mail asking them to reapply for qualified Medicare DMEPOS supplier status. If they don't reply within 30 days, fail to report a change in ownership or address, or don't report having staff or owners who have committed a felony within the past 10 years they will automatically be struck from the register.

CMS Acting Administrator Leslie Norwalk said:

"The concept is straight forward and will be effective. 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."

Suppliers in the two metropolitan areas can also expect to be visited at least once in the next two years said another CMS official.

The HHS also has several programs to help Medicare beneficiaries to protect themselves against fraud. One of these was established by the Administration on Aging and is called the Senior Medicare Patrol program. The program educates and helps beneficiaries to protect their Medicare information, detect billing errors and report suspected fraud and abuse.

Assistant Secretary for Aging Josefina G Carbonell said:

"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."

Click here for US Department of Health and Human Services (HHS).

Click here for Centers for Medicare & Medicaid Services (CMS).

Written by: Catharine Paddock
Writer: Medical News Today
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today