CMS' 2006 claims that it had reduced Medicare durable medical equipment role player to around $700 one thousand thousand were based on improper auditing and fell short of the actual amount of money of fraud, according to a gulp report by the HHS Office of Inspector General, the New York Times reports.
According to the report, at issue is the auditing on which CMS based its role player reduction claims. The Times reports that CMS chartered AdvanceMed, a subsidiary of Computer Sciences Corporation, to audit Medicare DME disbursement. The report states that CMS officials told AdvanceMed to neglect an auditing program -- called Comprehensive Error Rate Testing, or CERT -- which is required by law. Under CERT, claims are indiscriminately selected and auditors compare invoices to physicians' records to ensure the disbursal was justified. The report says that AdvanceMed was told by CMS officials to only examine the invoices from DME suppliers.
The report set up that in fiscal year 2006, CMS failed to detect that more than one-third of spending on DME was fraudulent. Using data from other Medicare reports, the undiscovered fraud would be about $2.8 1000000000000, according to the Times. The report found that AdvanceMed auditing revealed 7.5% of Medicare DME claims were not supported by documentation. The OIG report states that AdvanceMed would have discovered that 31.5% of claims were non supported by documentation had it used CERT.
The draft report was obtained by the Times and likely will be released within the next week. OIG might change or cut its findings before the release, according to the Times.
Reaction
CMS has been "lobbying the examiner to play down the report's conclusions," according to the Times. CMS voice Jeff Nelligan said, "Allegations of use of this error rate are ludicrous," adding, "The agency has aggressively targeted fraud and improper payments in the DME program." A CMS spokesperson aforesaid that the fraud figures should get been higher than $700 million, simply agency officials say the $2.8 billion trope is unsupported, the Times reports.
Some lawmakers and congressional staff members say that the account raises concerns about the credibility of other CMS figures. Senate Finance Committee ranking member Chuck Grassley (R-Iowa) aforesaid, "This is outrageous," adding, "If heads don't roll, you can't change the culture of this organisation." House Ways and Means Health Subcommittee Chair Pete Stark (D-Calif.) said, "To look better to the public, you cook the books," adding, "This representation is incompetent" (Duhigg, New York Times, 8/21).
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