Millions of dollars in Medicare reimbursements are being distributed based on fraudulent claims, according to an article at News4Jax.com. According to the article, the Center for Medicare and Medicaid Services (CMS) has allowed alleged businesses who claim to be medical equipment suppliers to sign up for Medicare reimbursement eligibility when they were in fact sham businesses that never provided medical supplies to patients. The Medicare reimbursement process is supposed to work by legitimate medical equipment companies providing medical supplies to Medicare eligible patients pursuant to a legitimate doctor’s prescription. The medical equipment supplier then bills Medicare for the cost of the medical supplies given to the patient. In one example from the article, a business used a utility closet as the address it provided Medicare and no one found out until after $77,000 in Medicare reimbursements were paid out.
What often happens is that sham companies enroll in the Medicare reimbursement program and submit reimbursement claims for supplies that were never provided or for amounts much greater than the value of the supplies provided. The CMS has indicated an intention to change the enrollment procedures for Medicare reimbursement eligible companies to try and prevent fraudulent claims. The idea is to make sure medical supply companies meet certain standards before they become eligible to bill Medicare for supplies they provide patients.
Among the changes that have been suggested to change the Medicare enrollment process are: requiring suppliers to maintain supporting records from doctors, limiting the use of cell phones or pagers as a business’s primary contact number and setting up a competitive bidding process for medical equipment.