Banned DME suppliers continued to collect Medicare money
Healthcare Auditing Weekly, December 16, 2008
In a November report, the OIG said that suppliers of durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) collectively had $352 million in debt deemed “currently not collectible” (CNC) in 2005. In 2006, DMEPOS supplier debt deemed CNC rose to $402 million.
CMS deems a Medicare overpayment to be CNC if the overpayment to the DMEPOS supplier remains uncollected 210 days after the date of the first demand letter.
In addition, OIG investigators and assistant U.S. attorneys found that DMEPOS suppliers with outstanding Medicare debt were operating businesses that were publicly fronted by business associates, family members, or others in order to receive Medicare payment.
For this review, the OIG randomly selected a sample of 10 DMEPOS suppliers in Texas that each carried Medicare debt of at least $50,000 deemed CNC by CMS during 2005-2006. The OIG found that six of the 10 DMEPOS suppliers were associated with 15 other DMEPOS suppliers or home health agencies (HHA) that received $58 million in Medicare payments during 2002-2007. Most of the associated DMEPOS supplier had lost their Medicare billing privileges y January 2005 and had accumulated $6.2 million in CNC debt.
Because of the limited sample size, the OIG was hesitant to give comprehensive conclusive results. More research is in the works. However, they did recommend CMS conduct similar reviews and compare its list of suppliers with CNC debt against public records to determine if the owners or managers appear to own or manage other suppliers or HHAs.
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