Senator Charles Grassley (R-Iowa) [pictured, top left] demanded a “full accounting” of how and why CMS failed to detect what appears to be a much higher incidence of improper DME payments than originally reported. Specifically, Grassley cited the recent OIG report that determined a 2006 DME error rate of close to 30%, not 7.5% as originally reported.  “I am deeply disturbed by the findings of the OIG Report and by the failures of the Centers for Medicare and Medicaid Services (CMS),” wrote Grassley in a letter to CMS this week. “What is even more alarming is that it appears that CMS may have deliberately instructed the contractor to take the unusual step of undertaking a limited review of the available data so as to make the error rate calculation far smaller than it was in reality.”

As reported in the Miami Herald earlier this week, a federal inspector general denounced Medicare for failing to properly audit medical equipment suppliers’ claims, a mistake that has likely cost taxpayers “hundreds of millions” of dollars a year. “The inspector general at the U.S. Department of Health and Human Services ordered fixes to help reduce fraud, waste and abuse in the giant government health insurance program,” wrote Jay Weaver, a reporter at the Herald. “Among them: Confirm that doctors actually prescribed equipment, providers delivered it and patients received it.”

The Herald also revealed that Rep Ileana Ros-Lehtinen, (R-Miami), sent a letter earlier this week asking the House Committee on Oversight and Government Reform, headed by Rep Henry Waxman (D-Calif), to call for hearings this fall. “I highly urge that the appropriate hearings be held in order to determine the cause of this alleged misreporting,” Ros-Lehtinen wrote to Waxman and the committee’s ranking Republican, Tom Davis of Virginia.
 
“Sen Grassley’s call for congressional hearings regarding the Inspector General’s report on the 2006 CERT [comprehensive error rate testing] audit inconsistencies is valid,” says Georgie Blackburn (pictured), vice president of government relations at Blackburn’s, Tarentum, Pa. “If CMS directed auditors to bypass policy requirements, that begs the question, why and maybe even who?”

Blackburn contends that unless providers, CMS, and doctors all work together, fraud can’t be properly addressed. “Until doctors (and other professionals) are given a mandated format, and until they are held accountable for what they write, the lack of evidence in medical records will continue and providers will pay the price,” adds Blackburn. “Providers simply are not able to be the only gatekeepers. CMS must take the high road with educating doctors, and then they must make them accountable for what is required.  CMS must initiate front-end edits as previously suggested by the OIG to negate payment of fraudulent claims. We must create a better way in the interim until electronic formats save the day and the Medicare budget.”

Unlike last week’s article in the New York Times, the Miami Herald article does not rehash competitive bidding with quotes from CMS officials. Instead, the Herald article does come in the wake of intense coverage of Medicare fraud, including an earlier opinion piece in which the newspaper declared: “Although Medicare fraud is prevalent all over the country, it is most heavily concentrated in South Florida, giving our area the unwelcome distinction of being the Medicare fraud capital of the nation.”