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Senate report finds Medicare fraud tied to improper code use

This article was originally published in The Gray Sheet

Executive Summary

Questionable diagnostic codes were used in millions of Medicare claims totaling over $1 billion, according to a review of CMS data from 1995 to 2006 outlined in a Sept. 24 report by Republicans on the Senate Homeland Security investigations subcommittee. CMS "does not review the claims to determine whether the diagnoses are remotely related to the purchased medical equipment," according to the report, entitled "Medicare Vulnerabilities: The Use of Diagnosis Codes in DME [durable medical equipment] Claims." For example, the subcommittee found "hundreds of thousands of claims" for blood glucose test strips with corresponding diagnoses of chronic airway obstruction, bubonic plague, leprosy, typhoid or cholera instead of diabetes. The report recommends CMS strengthen its review process and contractor oversight, link diagnosis codes with medical procedures and link claims for DME items with claims for medical treatment
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