In response to concerns that the Centers for Medicare and Medicaid Service’s (CMS) oversight of suppliers of durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) is inadequate to prevent fraud and abuse, the Government Accountability Office (GAO) conducted covert testing of the DMEPOS process. It found that weaknesses in the DMEPOS enrollment and inspection process have allowed sham companies to fraudulently bill Medicare for unnecessary or nonexistent supplies. It also confirmed the CMS estimate that from April 2006 through March 2007, Medicare improperly paid $1 billion for DMEPOS supplies--in part due to fraud by suppliers.
Specifically, in response to concern about vulnerabilities in the enrollment process, GAO used publicly available guidance to attempt to create DMEPOS suppliers, obtain Medicare billing numbers, and complete electronic test billing. GAO also reported on closed cases provided by the HHS Inspector General to illustrate the techniques used by criminals to fraudulently bill Medicare. Read the report highlights.
