OIG Examines Program Integrity Issues with New DMEPOS Suppliers
The OIG has issued a report entitled “Program Integrity Problems with Newly Enrolled Medicare Equipment Suppliers.” The OIG reviewed 229 suppliers that initially enrolled in Medicare in 2008 (before new ACA enrollment screening provisions went into effect), at which time the National Supplier Clearinghouse (NSC) assigned new supplier applicants a risk rating called the Fraud and Abuse Indicator of Risk (FAIR). According to the OIG, during their first year enrolled in Medicare, 26% high/medium-risk DMEPOS suppliers and 2% of low/limited-risk suppliers required CMS enforcement actions. Some suppliers in the OIG sample received significant Medicare reimbursement before being subject to their first post-enrollment site visit and CMS enforcement action. The OIG also found that some suppliers omitted from their enrollment applications required information regarding ownership, management, criminal histories, or adverse legal actions. While the OIG notes that the ACA strengthened CMS program integrity authorities, “further scrutiny of the riskiest applicants and enrolled suppliers is needed to prevent dishonest individuals from receiving Medicare payment.” The OIG therefore recommends that CMS conduct post-enrollment site visits earlier for new suppliers that receive the most money from Medicare, apply investigative techniques and tools to identify any owners or managers of suppliers who are not reported on supplier applications as required, and take appropriate action regarding suppliers that omit information from applications. CMS concurred with the recommendations.
