tci Medicare Compliance & Reimbursement - 2009 Issue 4
FRAUD & ABUSE: Suppliers Take More Heat For Dead Doc Billing
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Article Overview
This article covers a fraud-and-abuse topic focused on Medicare durable medical equipment claims and physician identifier integrity. It discusses an HHS Office of Inspector General report, CMS’s comments, and the broader compliance concerns for suppliers handling physician referral information and provider identifiers. The piece is relevant to billing, compliance, and audit professionals who need to understand why these claims are drawing scrutiny and what kinds of policy and systems issues are being reviewed.
Why This Topic Matters
Billing for DME claims depends on accurate provider identifiers and compliant claims processing. This article matters because it highlights federal oversight of identifier-related payment errors, the compliance risks for suppliers, and the possibility of operational changes that could affect claim submission workflows.
What You Will Learn
- Why Medicare DME claims involving physician identifiers are under scrutiny
- What the OIG report says about inactive, invalid, and deceased physician identifier issues
- What CMS is being asked to review in response to the report
- How supplier billing practices may be affected by future claims system or policy changes
Who Should Read This
- Durable medical equipment suppliers
- Medical billing and coding professionals
- Compliance officers
- Revenue cycle staff
- Healthcare auditors
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