TBO.com - TBO is Tampa Bay Online

Report Details Lax Medicare Oversight

ADVERTISEMENT

The Associated Press

Published: September 24, 2008

WASHINGTON - The government paid more than $1 billion in questionable Medicare claims for medical supplies that showed little relation to a patient's condition, including blood glucose strips for sexual impotence and special diabetic shoes for leg amputees, congressional investigators say.

Billions more in taxpayer dollars may have been wasted in the past decade because the government-run health program for the elderly and disabled paid out claims with blank or invalid diagnosis codes, such as a "?" or "zzzzz." Medicare officials say even smiley-face icons could have been accepted.

The report by Republicans on the Senate Homeland Security investigations subcommittee, obtained by The Associated Press, is the latest to detail lax oversight in the $400 billion program that has been cited by government auditors as a high-risk for fraud and waste for nearly 20 years.

The panel's review of millions of claims submitted by sellers of wheelchairs, drugs and other medical supplies on behalf of Medicare patients from 2001 to 2006 found at least $1 billion in which the listed diagnosis code appeared to have little, if any, connection to the reimbursed medical item.

For example, blood glucose test strips are almost exclusively used for diabetics. But Medicare paid millions of dollars to medical suppliers for the test strips without question based on non-diabetic diagnoses ranging from typhoid and bubonic plague to chronic airway obstruction and "psychosexual dysfunction."

Other questionable claims included wheelchairs or wheelchair accessories for patients listed as having a deformed nose or sprained wrist; special shoes for diabetics or shoe inserts for those with leg amputation or "precocious sexual development"; and walkers for people diagnosed with paraplegia.

"Since when did doctors start prescribing blood glucose test strips for the bubonic plague?" Minnesota Sen. Norm Coleman, the top Republican on the panel said Tuesday. "CMS's review process simply doesn't check to see whether the claim makes sense and that leaves Medicare vulnerable to fraud, waste, and abuse. Bottom line: we need to know where our Medicare dollars are going."

The Senate report urged the Centers for Medicare and Medicaid Services to consider new procedures to prevent fraud by reviewing whether diagnosis codes are medically related to the supplies being reimbursed, and to reject claims with any invalid or incorrect codes. Currently the agency generally just checks to see whether the coding is listed in the proper format before making payment.

The Senate investigation was conducted by both Democratic and Republican committee staff. Sen. Carl Levin, D-Mich., who chairs the subcommittee, declined to sign onto the final report, citing lack of time for review due partly to congressional efforts in the Wall Street bailout.

Share this:

Loading Comments...

Email Print

ADVERTISEMENT