Medicare Spending Billions Of Dollars On Questionable Claims For Medical Equipment, Report Finds

Main Category: Medicare / Medicaid / SCHIP
Also Included In: Medical Devices / Diagnostics
Article Date: 25 Sep 2008 - 5:00 PDT

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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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