By Bankrupting America
On July 21, The Government Accountability Office (GAO) announced the systems Centers for Medicare & Medicaid Services (CMS) uses to detect fraud and abuse might not be working properly. According to the report, “Two of CMS’s procedures appear to be working to screen for providers and suppliers listed as deceased or excluded from participating in federal programs or health care– related programs. However, GAO identified the following weaknesses in the other two procedures: CMS’s verification of provider practice location and physician licensure status.” Today’s Top 5 Things To Know will take a closer look at the report.
- In Total, Medicare Paid $554.2 Billion For Health Care And Health Care-Related Services During Fiscal Year 2014. According to the GAO, “Medicare is the federally financed health-insurance program for persons age 65 or over, certain individuals with disabilities, and individuals with end-stage renal disease.1 In fiscal year 2014, Medicare paid $554.2 billion for health care and health care–related services.”
- CMS Estimated That Roughly $59.9 Billion, Or 10.8 Percent Was Paid Out Improperly Leading To Medicare Being Classified As A “High-Error” Program. The GAO reported, “According to the Centers for Medicare & Medicaid Services (CMS)—the agency within the Department of Health and Human Services (HHS) that administers the Medicare program—an estimated $59.9 billion (10.8 percent) of that total was paid improperly, which is an increase over the 2013 level. Due to the large dollar amount involved in improper payments, the Office of Management and Budget has placed Medicare on its list of high-error programs.”
- CMS Requires Doctors Who Receive Benefits Or Reimbursements For Medicare Funds To Be Registered As A Part Of The Provider Enrollment, Chain And Ownership System (PECOS). According to the GAO audit, “CMS requires prospective providers and suppliers to be listed in the Provider Enrollment, Chain and Ownership System (PECOS) to enroll in Medicare and bill for services provided to Medicare beneficiaries. PECOS is a centralized database designed to contain providers’ and suppliers’ enrollment information. According to CMS, there were about 1.8 million health-care providers and suppliers enrolled in PECOS as of December 31, 2014.”
- Of The 1.8 Million Doctors Registered In PECOS, GAO Found That 23,400 Addresses, Or 2.3 Percent Might Be Invalid. According to The Wall Street Journal, “The GAO says that some screening problems persist, however, among the 1.8 million providers enrolled to bill Medicare from nearly a million addresses. The report estimated that about 23,400 addresses might be invalid. The 2.3% of provider addresses the GAO estimated might be invalid could be the results of data-entry errors, according to written responses to the GAO by Jim Esquea, the assistant secretary for legislation for the federal Department of Health and Human Services.”
- Of The 23,400 Potentially Fraudulent Addresses, 46 (Of The 496 Sampled) Were Allowed To Enroll In Medicare With A Practice Location Inside A Mailing Store Similar To UPS. According to the GAO, “Some CMRA addresses are not listed as post office boxes. For example, during our review of the practice location addresses in PECOS, we identified 46 out of the 496 sample addresses that were allowed to enroll in Medicare with a practice location that was inside a mailing store similar to a UPS store. These providers’ addresses did not appear in PECOS as a post office box, but instead were listed as a suite or other number, along with a street address. Businesses can purchase a post office box that is listed to the public as a suite number in a business district from some commercial mailing businesses. By doing so, businesses can mask the identity of the address as a post office box.”
Source: GAO: Problems With Medicare’s Screening Process | Bankrupting America | Government spending and waste in Washington, DC are bankrupting America and increasing our national debt to nearly $17 trillion.