Medicare is pretty easily duped, we learned from a Government Accountability Office report out today on problems in the cost of wheelchairs and other supplies.
We have to say that we’ve read more than our fair share of wonky reports about health care, and probably found them more entertaining than we should have. But this one sets a new standard for unintentional fun.
The GAO was checking up on whether Medicare has enough safeguards in place to prevent fraudulent billing for durable medical equipment like wheelchairs and walkers. So the investigators for GAO went undercover and created two fake companies specializing in “DMEPOS,” a mellifluous acronym for “durable medical equipment, prosthetics, orthotics and supplies.”
GAO went so far as to use undercover bank accounts and rent commercial offices for the companies, which purportedly sold “commodes, diabetic supplies, surgical dressings, urinals and bedpans, walkers and canes, and manual wheelchairs.” It then tested whether they could get Medicare billing privileges despite their having no customers and no products in stock.
A Medicare contractor that screens suppliers visited the companies’ offices, and Medicare initially denied their applications in part because the vendors had no inventory. The GAO then fabricated contracts with nonexistent wholesale suppliers. And it left a contact number for those contracts that rang at an “unmanned undercover telephone in the GAO building,” the report says. When Medicare’s contractor left a message there requesting more info, a GAO investigator left “a vague message in return” pretending to be the supplier.
Voila! Medicare billing number granted.
“Once criminals have similarly created fictitious DMEPOS companies, they typically steal or illegally buy Medicare beneficiary numbers and physician identification numbers and use them to repeatedly submit claims,” GAO said.
Read the lurid cat-and-mouse tale in its entirety here.
Medicare spokesman Jeff Nelligan told the Health Blog that Medicare has started a new program requiring accreditation of such suppliers, and it’s led to revocations of some suppliers’ billing privileges. (The program will be fully rolled out by September 2009.)
Medicare is also implementing rules that will, among other things, require that suppliers keep supporting paperwork from doctors and limit the use of cellphones and pagers as a primary business number. Nelligan also noted that Congress recently delayed a competitive-bidding program for durable medical equipment.
Photo: iStockphoto
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