tci Medicare Compliance & Reimbursement - 2008 Issue 31

Fraud & Abuse: Firestorm Erupts When CMS Lowballs DME Error Rate

Suppliers are caught in the crossfire between CMS, OIG, and politicians. Suppliers can expect even more scrutiny from Medicare thanks to a new scandal about CMS' CERT program. In a new report, the HHS Office of Inspector General chastises the Centers for Medicare & Medicaid Services and its Comprehensive Error Rate Testing (CERT) contractor AdvanceMed for calculating misleading durable medical equipment payment error rates. CMS gave AdvanceMed oral directions to use less stringent review criteria for DME claims when calculating the 2006 CERT rate, says the OIG's report (A-01-07-00508). Those instructions led to a 7.5 percent error rate...

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