Senate exposes 'dead-doctor' HME scam

Sunday, July 13, 2008

WASHINGTON - Fraudulent home medical equipment providers have billed Medicare for up to $92.8 million using the IDs of dead physicians, members of a Senate subcommittee charged during a hearing last week.

"Using the ID numbers of dead doctors, these scam artists have treated Medicare like an ATM machine, drawing money out of the government's account with little fear of getting caught," stated Sen. Norm Coleman, R-Minn., in a release.

Coleman is the ranking member of the Permanent Subcommittee on Investigations, which held the hearing. The subcommittee is part of the Committee on Homeland Security & Government Affairs.

Subcommittee members charged providers with billing Medicare using the UPINs of dead physicians for about $60.3 million to $92.8 million from 2000 to 2007. That's only for claims submitted at least 12 months after the physicians died.

"If claims within 12 months of the physicians' deaths were included, the estimate of claims paid over that timeframe would likely reach over $100 million," according to the release.

Subcommittee members acknowledged, "Medicare's review process has not worked properly to ensure dead doctors are removed from the system and that claims linked to those doctors are rejected."

"This is simply unacceptable," Coleman stated. "It's time to close this $100 million loophole."

Responding to the subcommittee's findings, AAHomecare stated: "Manufacturers and providers are just as appalled as lawmakers and Medicare officials at the revelations that scam artists used identification numbers from deceased doctors to bilk millions of dollars from the Medicare system."

The association went on to say, however, that "We must also be clear that it was lax oversight by CMS that allowed the dead-doctor scams to operate. We fully support comprehensive efforts to keep supplier billing numbers out of the hands of these scam artists."

At the hearing, Medicare officials told subcommittee members that the agency plans to match monthly Social Security data about U.S. deaths against its revamped provider-identification system. It also pointed out that it has implemented new accreditation requirements for providers.

The Office of Inspector General (OIG) first investigated the billing loophole in 2001. It found that Medicare paid for $91 million for medical supply claims with invalid or inactive physician ID numbers in 1999.