Congress cries foul over report of inaccurate DME fraud prevention claims

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Congress cries foul over report of inaccurate DME fraud prevention claims
Congress cries foul over report of inaccurate DME fraud prevention claims
Many lawmakers are outraged after allegations surfaced that the Centers for Medicare & Medicaid Services misled Congress into thinking it had significantly reduced the number of fraudulent claims for durable medical equipment (DME).

In 2006, CMS claimed it had prevented billions of dollars in fraudulent claims from being processed, and reduced the cost of DME fraud to $700 million. But according to a report in The New York Times this week, these claims are inaccurate and improper spending on fraudulent claims totaled about $2.8 billion. The Times cited a confidential draft of a federal inspector general's report as proof of the allegations. Sen. Charles Grassley (R-IA) has called the situation "outrageous." Rep. Pete Stark (D-CA) told the Times he isn't surprised by the irregularities, calling CMS an incompetent agency.

Meanwhile, CMS reportedly is preparing to implement its competitive bidding program for durable medical equipment, prosthetics and orthotics suppliers (DMEPOS). The program originally was scheduled to begin on July 1 of this year, but recently was delayed by Congress for 18 months and will not begin until 2010. The competitive bidding program, CMS hopes, will reduce DME costs to Medicare and, at the same time, reduce fraudulent payments. Some opponents of the program have argued that smaller businesses will not be able to compete with larger DME suppliers for contracts.