Corporate Compliance

Dead doctors bill Medicare for an estimated $92 million

Compliance Monitor, July 16, 2008

On July 9, the US Senate Permanent Subcommittee on Investigations estimated between $60.3 million and $92.8 million worth of Medicare payments were issued to companies that used the Unique Physician Identification Numbers (UPIN) of deceased doctors. Furthermore, 63% of the claims the committee identified as being billed by deceased doctors occurred after CMS implemented changes to stop such abuse from occurring.
 
According to the report, CMS does not deny these abuses and has taken steps to further prevent abuse from occurring. Most recently, CMS terminated the UPIN system and replaced it with a new National Provider Identifier (NPI) number system for all Medicare providers. The new NPI numbers have been required for Medicare claims since May.
 
During testimony before the committee, Herb Kuhn, Deputy Administrator of CMS, said he believes the NPI system will reduce the likelihood of deceased doctors billing Medicare in the future because NPIs will be cross-referenced with Social Security records to make sure doctors with registered NPIs are not deceased.
 
In his testimony, Robert Vito, Regional Inspector General for Evaluation and Inspections, stated the new NPI system is still vulnerable to abuse and CMS must conduct post payment reviews that will identify:
  • When there are spikes in the use of a particular NPI
  • When the NPI is consistently associated with an aberrant number of claims
  • When the NPI used on claims is not in the geographic vicinity of the beneficiary
To read the testimony from the Senate Permanent Subcommittee on Investigations hearing, click here.

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