Medicare Chief Rolls Out Expanded Efforts To Crack Down on Fraud
On Monday, CMS announced new efforts to detect and combat Medicare fraud committed by durable medical equipment suppliers and home health care agencies, CongressDaily reports.
Under the plan, the agency will expand a recovery audit contractor program nationwide. The program ran as a three-year demonstration project in six states and recovered $900 million in overpayments (Edney, CongressDaily, 10/6).
Contractors will focus on companies and individuals whose Medicare billings are higher than those submitted by the majority of providers and suppliers in a community. The contractors will be compensated based on the overpayments and underpayments they identify (Carey, CQ HealthBeat, 10/6).
CMS will pay particularly close attention to DME suppliers in California, Florida, Illinois, Michigan, New York, North Carolina and Texas. DME suppliers in those states will be subject to more thorough examination of claims, and CMS will make unannounced visits to ensure the companies are in business (CongressDaily, 10/6).
In addition, the agency will conduct more in-depth background checks of DME suppliers, as well as more interviews with beneficiaries to see whether they received supplies and whether they were qualified to receive benefits.
Home Health in Florida
CMS also announced that it will take targeted steps to combat fraud by home health care agencies in Florida who claim to provide services for sicker-than-average beneficiaries and receive special additional payments.
Those payments represented 60% of all home care bills paid by Medicare in Miami last year, compared with the national average of 6%.
CMS acting Administrator Kerry Weems announced the suspension of payments to the 10 Miami-area home health care agencies that receive most of these payments, pending an investigation.
Walter Gorski -- vice president of government affairs for the American Association of Homecare, which represents DME suppliers -- said the organization agrees with many of CMS' plans. "A lot of what they're saying is what they should be doing already," Gorski said (Appleby, USA Today, 10/7).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.