Fraud and abuse from Medicare suppliers remains a problem for Medicare and Medicaid, says the Office of Inspector General (OIG) in Washington. In an examination that divided the suppliers into high, medium and low-risk categories, OIG found that 26% of the high and medium-risk suppliers and 2% of the low-risk suppliers had been placed on prepayment claims review or had their billing privileges revoked. Other suppliers had failed to provide necessary management information. Particularly egregious were the enrolled suppliers who had left out information about criminal histories or adverse legal action.
To combat and prevent the risk from dishonest and harmful suppliers, OIG recommends earlier and more frequent post-enrollment site visits to the suppliers, as well as appropriate follow-up regarding missing information on applications. The Centers for Medicare & Medicaid Services (CMS) say they have heeded this advice and have begun to implement measures that will lead to increased overall security.
Hopefully, increased action on the part of CMS will both rid the system of fraudulent suppliers and deter potential suppliers from following in the footsteps of unchecked wrongdoers. Ethical practices from medical suppliers should not only be hoped for, but expected. Resources are available in California to locate and combat fraudulent healthcare services.