Home Health & Hospice Week

Congressional hearing focuses on HME claims using deceased physicians' UPINs. Medicare may have switched to using National Provider Identifier numbers for physicians, but that hasn't stopped a brouhaha over UPIN numbers from catching national attention. A July 9 hearing of the Senate Permanent Subcommittee on Investigations focused on durable medical equipment claims that used deceased physicians' UPINs. "From 2000 to 2007, the UPINs of more than 17,000 deceased physicians were used on close to 500,000 erroneous claims that were paid over $76 million," said Subcommittee Chair Carl Levin (D-MI) in a statement for the hearing. "The failure to reject these claims raises questions about who at Medicare is safeguarding taxpayer dollars and why basic protections are not in place." Fraudulent suppliers can easily obtain dead docs' numbers or can use the numbers in collusion with physicians, a New York Times article noted. "Scam artists have treated Medicare like an automated teller machine, drawing money out of the government's account with little fear of getting caught," said Sen. Norm Coleman (R-MN), ranking member on the subcommittee. New risk: The problem may get even worse under the new NPI system, pointed out the HHS Office of Inspector General's Robert Vito in testimony for the hearing. Currently the Centers for Medicare & Medicaid Services is allowing all Medicare providers, including DME suppliers, to put their own NPIs in the referring/ordering physician field on the claim. "As long as DME suppliers are allowed to enter their own NPIs rather than the NPIs of the ordering physicians, a major control for preventing fraud, waste and abuse will not exist," Vito warned. Rebuttal: "Durable medical equipment manufacturers and providers are just as appalled as lawmakers and Medicare officials at the revelations that scam artists used identification numbers from deceased doctors to bilk millions of dollars from the Medicare system," fired back the American Asso-ciation for Homecare in a statement about the hearing's findings. Suppliers who perpetrated such fraud "are not part of the legitimate home care industry," the trade group pointed out. AAHomecare urges CMS to adopt accreditation standards for suppliers and to enforce its current supplier standards with surprise on-site inspections. "Lax oversight" by CMS has "allowed the dead-doctor scams to operate," the group insists. CMS will begin double-checking Social Security death information against physician information on claims, CMS' Herb Kuhn said at the hearing. And the reenrollment required by the NPI process should weed out many deceased physicians' numbers, Kuhn added. The fraud details are "gory," said the USA Today in a July 10 op-ed piece. But "obsessing over the dead-doctor scam is a little like focusing on the guy stealing some silverware from the kitchen when the house is on fire," the newspaper [...]