tci Medicare Compliance & Reimbursement - 2008 Issue 33

Fraud & Abuse: Senate Wants Diagnosis Codes Linked To DME Claims

Report finds billions of dollars in questionable DME payments. Edits for durable medical equipment claims could get much tougher if the feds listen to a new Senate report. Medicare may be wasting billions of dollars on DME claims that aren't legitimate, says the report from the Senate's Permanent Subcommittee on Investigations under the Committee on Homeland Security and Governmental Affairs. "Medicare Part B, the component in which Medicare pays for certain durable medical equipment and supplies ... is particularly susceptible to abuse," the report says. The subcommittee found widespread problems when looking at diagnosis codes for certain DME items...

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