Our government at its finest


The Office of Inspector General (OIG) published a report yesterday that questions the error rate for DME claims for fiscal year 2008.  Each year, CMS’s Comprehensive Error Rate Testing (CERT) contractor conducts medical reviews of a sample of DME claims to determine an error rate. For FY 2008, CMS contracted with Palmetto GBA to conduct an independent review of the error rate. The OIG based its report on Palmetto's findings.

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Here's what baffles me: The government has several contractors processing claims (the DME MACs); it has a second contractor (the CERT) reviewing their work to determine an error rate; it has a third contractor (Palmetto) reviewing the second contractor's work; and it has a fourth contractor (the OIG) reviewing all of their work.

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This gives new meaning to bureaucracy.

Liz Beaulieu

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Isn't it a little disturbing that the OIG didn't even question whether or not Palmetto's standards were unrealistic? Palmetto has an established pattern of denying nearly 100% of any claims that it reviews only to have those denials overturned during administrative review. Shouldn't we be focused on this ridiculous waste of government funds? How about getting HME News to shine a little bit of the Fraud Spotlight in their direction on this issue? Thanks!!