Medicare : More Effective Screening and Stronger Enrollment Standards Needed for Medical Equipment

Summary: In FY 2004, the Centers for Medicare & Medicaid Services (CMS) est. that Medicare improperly paid $900 million for durable med. equip., prosthetics, orthotics, & supplies -- in part due to fraud by suppliers. To deter such fraud, CMS contracts with the NCS to verify that suppliers meet 21 standards before they can bill Medicare. NSC verifies adherence to the standards through on-site inspections & document reviews. R...ecent prosecutions of fraudulent suppliers suggest that there may be weaknesses in NSC's efforts to screen suppliers or in the standards. This report evaluated: NSC's efforts to verify suppliers' compliance with the 21 standards; the adequacy of the standards to screen suppliers; & CMS's oversight of NSC's efforts. Charts & tables. [read more]