60 Minutes shines bright light on Medicare's '$60 Billion Fraud' and guess what, the DME industry is not to blame

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10/26/2009

The news magazine “60 Minutes” tackled Medicare fraud and abuse in its lead story last night (“The $60 Billion Fraud”), and reporter Steve Kroft placed the blame squarely where it belongs: on Medicare.

This whole Medicare fraud thing really is a travesty, and CMS doesn’t seem to have a clue how to reduce it. One crook called defrauding Medicare as easy as “taking candy from a baby.” You just send in the claims, he said, and Medicare pays them.

Hang 'Em High dvdrip It’s pretty obvious from this story that CMS does very little to insure that providers are legitimate. Whatever happened to performing a site visit before handing out a provider number?  Many of these crooked providers operate out of dilapidated and abandoned storefronts and in some instance long-term storage facilities with no addresses. These providers are here today and gone tomorrow with millions in taxpayer dollars.

Medicare fraud and abuse is pervasive, Kroft demonstrated, and goes way beyond billing for unnecessary power wheelchairs and other DME. One hospital actually recruited homeless people to fill its beds.

The Medicare and law enforcement officials interviewed for the story hardly inspired confidence. The investigators seemed giddy to be on TV, and when questioned about how to reduce Medicare fraud, Kim Brandt, CMS director of program integrity, had no answers.

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In a particularly pathetic segment, beneficiaries told how Medicare officials ignored (sometimes for years) their reports of fraud and abuse.

Controlling Medicare fraud and abuse is a challenge, no doubt, but trying to do so with a slew of post-payment audits seems like putting the cart before the horse. Any meaningful strategy must start with qualifying providers upfront. You can’t pay claims and ask questions later.

I think health care reform is badly needed, but if CMS doesn't change how it operates, it could end up as just another big payday for the crooks.


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