Corporate Compliance

CMS paid billions in questionable claims

Healthcare Auditing Weekly, September 30, 2008

A report from Republicans on the Senate Homeland Security investigations subcommittee sites poor oversight as the reason for CMS paying more than $1 billion in dubious medical supply claims.
 
An article from the Associated Press reported on the findings of the panel. The panel found that from 2001 to 2006, CMS paid claims for medical supplies intended for seemingly unrelated conditions. Examples include claims for blood glucose strips for patients diagnosed with sexual impotence, special diabetic shoes for leg amputees, and wheelchairs for patients with sprained wrists.
 
The panel also found that billions more have been wasted on claims with blank or invalid diagnosis codes. Some paid claims featured question marks, “zzzzz,” and smiley face icons, according to the AP article.
 
CMS defended its practices, explaining that claims made before 2003 didn’t have proper diagnosis codes because federal regulations were unclear whether these codes were required to process a claim.
 
However, from 1995 to 2006, CMS paid approximately $4.8 billion for claims submitted with blank or invalid diagnosis codes. CMS paid about $23 million of that amount after 2003. Investigators found 30% of a 2000-claim sample had fraudulent characteristics, such as dead doctors and retired doctors who denied authorizing the treatment or making the diagnosis, according to the AP article.

Comments

0 comments on “CMS paid billions in questionable claims ”

 

Most Popular

Related Articles