Notable & Quotable

Citing egregious examples of DME Medicare fraud — including one supposed provider who used taxpayer money to buy a Rolls Royce — CMS has announced a massive anti-fraud demonstration program for 7,700 providers in the Los Angeles and Miami metro areas. The agency said each provider would be mailed a notice to reapply for Medicare billing privileges. They can also expect multiple unannounced site visits. The pilot will run for two years, and could expand to other parts of the country. Industry reaction: What took you so long, CMS? $37.2 billion Cost to the U.S. in 2004 for COPD, including $20.9 billion in health care expenditures, $7.4 billion in indirect morbidity costs and $8.9 billion in indirect mortality costs.

Source: American Lung Association

“ Medicare and its private contractors have failed to shoulder the proper responsibility to effectively exercise their already-existing authority to combat fraudulent activity. They must insist on standards and other up-front controls that will deny illegitimate operators any chance of taking advantage of Medicare …”
— The American Association for Homecare, in an open letter to Congress in popular Capitol Hill newspaper Roll Call. The June letter charged that the government has not done its job in curbing DME fraud and that providers need “clear, up-to-date and fair federal regulations that effectively target fraud and abuse but at the same time do not unduly burden those companies that make every effort to follow the rules.” $350 billion Value of informal care provided by family caregivers in 2006, an amount equivalent to total expenditures for the Medicare program in 2005 ($342 billion) and larger than the total U.S. budget deficit last year ($248 billion).

Source: AARP Public Policy Institute $21 million Amount CMS overpaid in improper claims for negative wound therapy pumps and accessories in 2004. A review was initiated after claims shot up by 444 percent between 2001 and 2005, from $25 million to $136 million.

Source: HHS Office of Inspector General