For more than 40 million seniors and disabled persons, Medicare provides necessary health care benefits. Unfortunately, however, this crucial program can also be a target for fraud. With overall health care costs rising, it is important to scrutinize carefully where waste, fraud, and abuse can be eliminated to save taxpayers money and to ensure that Medicare is available to those who rely on the program. This is an ongoing process as there are always new scams and unscrupulous people looking to take advantage of Medicare, its recipients, and the American taxpayer.
Recently, the Senate Permanent Subcommittee on Investigations, which is charged with making sure government programs such as Medicare are run properly, completed an investigation that once again proves that we must constantly be vigilant in our efforts to root out waste, fraud and abuse. The Subcommittee’s investigation found that Medicare paid as much as $92 million over the past seven years for durable medical equipment such as wheelchairs, prosthetics, hospital beds, and other home medical equipment purportedly prescribed by physicians. There was one big problem. The doctors were all deceased. In fact, many of these doctors had died ten years or more before the service date on the claims, making it impossible for them to have written the prescriptions.
It is troubling that Medicare does not have a better system in place to ensure the validity of physician prescriptions for durable medical equipment or other services.
Each medical provider is given a Unique Physician Identification Number (UPIN). This number must be provided on every claim filed with Medicare, along with identifying information for the Medicare recipient and the supplier of the medical equipment. As the investigation showed, however, some con artists filed false claims with Medicare using the identification numbers of doctors who have passed away.
The Subcommittee investigation selected 1,500 random doctors who died between 1992 and 2002. It then looked at the number of claims filed with Medicare using the same doctors’ identification numbers between 2000 and 2007. The investigation found that nearly half of the numbers assigned to these doctors were used to file claims. In total, the numbers of 734 deceased doctors were used for 21,458 claims for reimbursement.
In one case, the Subcommittee found that the identification number belonging to a Florida doctor who died in 1999 was used fraudulently by at least three different medical equipment suppliers on Medicare claims up to eight years after the doctor’s death. Two of these scam artists were convicted. In another case, more than 3,800 Medicare claims were filed up to six years after the doctor whose number was used passed away in 2001. More than $354,000 was paid out in these claims.
These problems are not new. In 2001, the Department of Health and Human Services Inspector General reported that Medicare paid $91 million in 1999 for medical equipment and supply claims with invalid or inactive identification numbers.
In response to that 2001 report, the Centers for Medicare and Medicaid Services did take steps to reject claims containing the provider identification numbers of deceased physicians. However, the safeguards put in place at that time have evidently not been successful, since claims are still being paid based on doctors who have died.
There are several steps Medicare needs to take to solve this problem once and for all. After a doctor passes away, retires, or has a medical license revoked, Medicare should have a system in place to automatically deactivate their UPIN. Then, if a con artist tries to use an invalid UPIN, either by accident or for deceptive purposes, Medicare should automatically be alerted to ensure the claim is not paid. Medicare should then immediately investigate whether the provider intentionally used an inactive doctor identification number in an effort to defraud the government. If this is found to be the case, then severe penalties must be enforced to prevent future abuses of the system.
In addition, Medicare should have a system in place to periodically check and make sure UPINs of deceased doctors are being deactivated. Conducting such audits will prevent significant periods of time from passing before it is discovered whether or not UPINs are being properly deactivated.
Medicare must take strong and effective action to eliminate these fraudulent activities and make sure that the scam artists who deceive the program are fully prosecuted so others are deterred. Our nation’s taxpayers and the seniors and disabled Americans who depend on the Medicare program deserve no less.