Showing posts with label billing. Show all posts
Showing posts with label billing. Show all posts

Friday, June 29, 2018

Most Medicare Claims for Replacement PAP Device Supplies Didn't Comply With Medicare Requirements - OIG

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California HMDR Exemptee Training Certification:

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Read the full June 2018 report:

Most Medicare Claims for Replacement Positive Airway Pressure Device Supplies Did Not Comply With Medicare Requirements - DHS OIG (PDF - click this link)

"Most Medicare claims that DME suppliers submitted for replacement PAP device supplies did not comply with Medicare requirements. Of the 110 claims in our sample, 24 complied with Medicare requirements; however, 86 claims with payments totaling $13,414 did not. On the basis of our sample results, we estimated that Medicare made overpayments of almost $631.3 million for replacement PAP device supply claims that did not meet Medicare requirements."

The CMS expressed interest in educating health care providers on avoiding Medicare billing errors.

Return Home:  The Designated Representative and Exemptee Blog


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Training for HMDR Exemptee license applicants - Earn a course completion certificate - Accepted by the California Dept of Public Health (CDPH)


For Designated Representative license applicants  -  Training programs, courses, classes, seminars:

     California (earn a training affidavit):
     Florida:

For HMDR Exemptee license applicants  -  Training programs, courses, classes, seminars:

     California (earn a training completion certificate):

Tuesday, July 5, 2011

Phantom Pharmacy Scams Exploding

Updated February 7, 2026

The original link broke.

You might also be interested in this book:

PHANTOM BILLING, FAKE PRESCRIPTIONS, AND THE HIGH COST OF MEDICINE
Health Care Fraud and What to Do about It:
https://library.oapen.org/bitstream/handle/20.500.12657/62116/9780801460807.pdf

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Federal officials are watching as "a new fraud is spreading through the health care system. Criminal enterprises posing as pharmacies are billing Medicare, Medicaid and private insurers for fake prescriptions and bilking health care out of millions of dollars," reports this CNN Money article, Phantom pharmacy - A growing health care fraud.

You're probably reading this because you have an interest in CA or FL. The article also says, "scammers typically target Florida and California because they have large Medicare and Medicaid populations."

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Wednesday, July 21, 2010

Group Letter - Repeal Medicare Competitive Bidding for HME and Services

Updated July 26, 2021

The original link broke.

You can still read about this topic here:

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Thought you'd be interested in this Medical News Today article, Nearly 60 Homecare And Patient Advocacy Groups Urge Congress To Repeal Medicare's "Competitive" Bidding For Home Medical Equipment And Services.

Tyler J. Wilson, president of the American Association for Homecare in the open letter to Congress says:
"Our national, state and local organizations believe that this program is fundamentally flawed and will create significant obstacles to patient care while threatening the homecare infrastructure for our nation's seniors and disabled."

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Tuesday, June 23, 2009

Florida Cracks Down On Miami DME Fraud

Updated May 4, 2021

The original link broke.

You can still read about the topic here:

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The Miami Herald reports, Florida probes Miami-area medical-equipment kickbacks - Medicaid investigators are targeting fraud in Miami-Dade County, zeroing in on questionable billing for medical equipment. They report investigations of providers suspected of bilking the state healthcare program for low-income people by billing for oxygen concentrators that are not medically needed. Investigators also visited more than 120 Medicaid patients, some of whom may have received kickbacks from medical equipment suppliers for ordering their products. Of note, investigators indicate that unnecessary billing for oxygen concentrators has been a particular problem over the past five years. According to Holly Benson, secretary for the Florida Agency for Health Care Administration, said fraudulent billing for oxygen concentrators is the latest scam ailing Medicaid, which spent $90 million on medical equipment in fiscal 2007-08. About 25 percent of that spending, funded by state and federal taxes, was in Miami-Dade. In summary, it's especially important to have things in order if you're near Miami and billing for oxygen concentrators. 

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