Something's fishy: Dead doctors bill Medicare

Sunday, February 15, 2009

WASHINGTON - Medicare continues to allow medical equipment and supply claims with bogus physician identification numbers, according to an Office of Inspector General (OIG) report issued last week.

In 2007, Medicare allowed $34 million in claims with physician identification numbers that had never been issued or that had been deactivated. That includes $5 million for claims with numbers of dead doctors. Last year, a Senate subcommittee charged Medicare with allowing $60.3 million to $92.8 million in claims with numbers of dead doctors from 2000 to 2007.

"We recommend that CMS determine why claims with identifiers associated with deceased referring physicians continue to be paid," states the OIG report.

For a claim to be valid, suppliers must include their NPIs in the primary provider field and the referring physician's NPI in the secondary provider field. However, Medicare instituted a temporary provision that allows suppliers who cannot obtain a referring physician's NPI to instead use their NPIs in the secondary provider field.

The OIG recommends that Medicare implement claims-processing system changes to ensure that NPIs for both referring physician and suppliers listed on medical equipment supply claims are valid and active; emphasize to suppliers the importance of using accurate NPIs for both referring physician and suppliers; and determine the earliest date to end the provision that allows suppliers to submit claims without referring physician NPIs.

CMS concurred with the report and stated that it has taken steps to incorporate recommendations.