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CMS cracks down on fraud in South Florida

Device Regulation Alert: Safety, Compliance and Reimbursement News, October 13, 2008

On October 6, CMS announced it will ramp up efforts to curb Medicare fraud and abuse.

According to the CMS press release, the agency will focus more attention on Florida home health agencies and durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) suppliers in Florida, California, Texas, Illinois, Michigan, North Carolina, and New York. 

• Conduct more stringent reviews of new DMEPOS suppliers’ applications, including background checks to ensure a principal, owner, or managing owner has not been suspended by Medicare
• Make unannounced site visits to double check that suppliers and home health agencies are actually in business

• Implement extensive pre- and post-payment review of claims submitted by suppliers, home health agencies, and ordering or referring physicians
• Validate claims submitted by physicians who order a high number of certain items or services by sending follow-up letters to these physicians
• Verify the relationship between physicians who order a large volume of DMEPOS equipment or supplies or home health visits and the beneficiaries for whom they ordered these services
• Identify and visit high risk beneficiaries to ensure they are appropriately receiving the items and services for which Medicare is being billed

The attention being focused on Florida is not unfounded. The Florida Attorney General’s (AG) Office issued a press release September 30, which said the number of Medicare fraud cases in the state has steadily increased since 2006. For fiscal year 2008, the AG prosecuted 245 cases, with a corresponding fraud amount of $793 million.

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