From medical offices that claim to be operating out of vacant storage facilities to neurologists submitting bills for durable medical equipment having nothing to do with the brain, the companies that analyze bills for Medicare saw an eye-opening array of attempts at fraud in 2007 and 2008, says a new review from HHS' inspector general's office (PDF).
HHS finds wide array of Medicare scams
During those two years, the CMS suspended Medicare billing privileges for 260 different providers for overpayments estimated at more than $200 million. Nearly all of the providers received notice of the suspension the day that payments were halted or afterward—indicating that the CMS suspected outright fraud in almost every case, according to an analysis of the CMS' suspensions issued Nov. 1 by the inspector general's office.
Providers in Florida made up 35% of all the suspensions, while the rest of the states in the U.S. combined were home to another 39%, with the remaining 26% in Puerto Rico, according to the report. Researchers found that the median overpayment was $1.3 million, but only 7% of the overpaid funds was ever recovered.
The report from the inspector general's office comes as the CMS prepares to use new tools in the Patient Protection and Affordable Care Act to fight fraud, embodied in proposed regulations issued Sept. 23 defining what constitutes “credible allegations of fraud” used to suspend Medicare payments.
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