Here is the short. Seven durable medical equipment companies apparently cost the Medicare system $2 billion in fraudulent payments. Unfortunately, there is always a long when it comes to government fraud. These allegations come from a review by the National Association of Accountable Care Organizations (NAACOS) of two billing codes for Medicare claims. Over the last two years, NAACO found a massive spike in Medicare claims for catheters among seven medical equipment companies. Massive spike meaning, these seven companies went from billing 14 patients a year for catheters to nearly 406,000 patients a year. In 2021, urinary catheter payments to these companies accounted for $153 million before surging to $2.1 billion in 2023. For catheters. Tubes that patients insert several times a day to treat incontinence and drain bladders, along with the U.S. Taxpayer.
Where do you get half a million Medicare beneficiary names and ID numbers? Maybe a breach somewhere in the healthcare system. In July, the Centers for Medicare & Medicaid Services (CMS) announced more than 600,000 beneficiaries had their personal information exposed in a data breach. Shortly after, it was noticed that there was an increase in billing for catheters. Incontinence or fraud? Probably fraud. Medicare pays out about $8 per catheter. Yes, innocent until proven guilty. But because catheters are low-cost items, they may not receive as much scrutiny as pricier medical devices. Just saying. When ordered in bulk they could create a very nice profit for fraudsters. NAACOs found no evidence patients ordered the catheters on their own, though their Medicare numbers were used.
NAACOS concluded that seven companies were behind a surge of bills submitted to Medicare across the last two years for intermittent urinary catheters. However, the Washington Post examination of state and federal records found links among the companies, such as a matching address and officers listed at multiple organizations. Six of the seven companies had critical reviews on Yelp, the Better Business Bureau, Facebook or other sites complaining of Medicare fraud involving catheters. The Department of Health and Human Services should check those reviews out.
Today’s Fraud of The Day is based on article “’A giant unknown’: What the alleged $2B Medicare catheter fraud scheme means for ACOs” published by Fierce Health Care” on February 15, 2024
Seven durable medical equipment companies cost the Medicare system $2 billion in payments, the National Association of ACOs (NAACOS) told the federal government in recent months. But it’s unclear just how problematic that will be for accountable care organizations.
The association’s allegations come from a review of two billing codes for Medicare claims data from the Centers for Medicare & Medicaid Services (CMS) Virtual Research Data Center. They say urinary catheter payments to beneficiaries accounted for $153 million in 2021 before surging to $2.1 billion in 2023. Catheter spending by DMEs increased by 15.5% as false claims were filed around the country.
