Misleading Medicare Anti Fraud Claims

A CMS Report says that medicare durable equipment fraud had been reduced to about 700 mn USD. The New York Times however reports that the claims were based on improper auditing and were incorrect.

 

The issue is the auditing on which CMS fraud reduction claims are based. Based on a Times report AdvanceMed, a Computer Sciences Corporation subsidiary had been hired to audit medicare DME spending. Apparently AdvanceMed was told to ignore an auditing programe –CERT or Comprehensive Error Rate Testing. This program is required by law. AdvanceMed was apparently told by CMS officials to only examine DME supplier invoices.

According to the HHS Office of Inspector General report, in 2006, CMS did not detect that over a third of DME spending was fraudulent. The undiscovered fraud would equal $2.8 bn according to the Times. The draft report was obtained by the Times and would be released next week.

CMS spokesperson Jeff Nelligan said that allegations of manipulation were preposterous. Meanwhile some lawmakers and congressional staff members say that credibility of other CMS figures is in question with this report. Some were calling for heads to roll.