OIG to CMS: ‘Medicare Advantage is also at risk’

WASHINGTON – The Office of Inspector General (OIG) says it has identified gaps in the screening process for fraudulent DMEPOS suppliers in Medicare Advantage.

The agency issued a report on Sept. 9 saying Medicare Advantage organizations (MAOs) conduct some screening checks on in-network suppliers but fewer checks of out-of-network suppliers. It also says:

• The Centers for Medicare & Medicaid Services (CMS) does not screen all DEMPOS suppliers before they bill Medicare Advantage because they are not in enrolled in Medicare
• The fraud prevention tool the agency uses to prevent certain DMEPOS suppliers from billing Medicare Advantage – known as the Preclusion List – has limitations in preventing fraud

“Fraud related to DMEPOS has been a long-standing issue in Medicare, putting millions of taxpayer dollars at risk each year,” the OIG stated. “So far, CMS’s efforts to prevent DMEPOS fraud have mainly focused on original Medicare, not Medicare Advantage. Yet, Medicare Advantage is also at risk. With the recent growth in the number of enrollees, Medicare Advantage now accounts for more spending than original Medicare. In addition, OIG has seen fraud schemes – similar to those affecting original Medicare – also impacting Medicare Advantage.”

The OIG recommends:

• Ensuring that MAOs strengthen checks of out-of-network DMEPOS suppliers
• Strengthening the use of the Preclusion List to prevent fraudulent DMEPOS suppliers from billing Medicare Advantage
• Requiring that all DMEPOS suppliers that bill Medicare Advantage be enrolled in Medicare, or seek statutory authority to do so if necessary

The OIG says CMS concurred with or said it would take into consideration all recommendations.

Related reading:

• CMS adds 11 medical supply companies to Preclusion List.
• OIG to CMS: Stronger oversight efforts are needed for DMEPOS.