HHS’ Office of Inspector General released a report in September detailing gaps in efforts to reduce or halt medical equipment supplier fraud in Medicare Advantage.
Earlier in the month, CMS announced that it had barred 11 medical suppliers from receiving MA payments following a $3.4 billion fraud probe. Looking at suppliers of durable medical equipment, prosthetics, orthotics and supplies, OIG highlighted areas for both CMS and MA plans to revisit.
Here are four notes from the report:
1. MA organizations carry out some screening checks of in-network suppliers but fewer for those that are out of network.
2. Since not all of the equipment suppliers are enrolled in traditional Medicare, CMS does not screen every supplier before they bill MA.
3. While CMS uses its preclusion list to stop some suppliers from billing MA, there are limitations. Out-of-network suppliers that are not enrolled in traditional Medicare pose a heightened fraud risk.
4. OIG called for MA organizations to bolster their checks of out-of-network suppliers, as well as stronger reliance on the preclusion list and a pathway requiring DMEPOS suppliers billing MA be enrolled in Medicare. With all of these recommendations, CMS either agreed or said it would take them into consideration.
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