On September 15, 2010, Daniel R. Levinson, Inspector General of the federal Department of Health and Human Services (HHS), testified before the House Subcommittee on Health to discuss the Office of Inspector General’s (OIG) efforts to combat health care fraud, waste, and abuse, specifically as it relates to durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS).
Five-Principle Strategy
Levinson described the five principles OIG has identified as essential to combating healthcare fraud and the context for each principle.
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Enrollment: Scrutinize individuals and entities that want to participate as providers and suppliers prior to their enrollment or reenrollment in the health care programs.
Context: It has been too easy for fraudulent DMEPOS suppliers to obtain Medicare billing privileges. -
Payment: Establish payment methodologies that are reasonable and responsive to changes in the marketplace and medical practice.
Context: Medicare pays too much for certain DME items, resulting in waste for legitimate claims and making fraudulent billing more lucrative. -
Compliance: Assist healthcare providers and suppliers in adopting practices that promote compliance with program requirements.
Context: Compliance programs and education can assist legitimate DME suppliers in billing appropriately. -
Oversight: Vigilantly monitor the programs for evidence of fraud, waste, and abuse.
Context: Vigilant monitoring through data analysis and claims review is critical to preventing and detecting fraud, waste, and abuse. -
Response: Respond swiftly to detected fraud, impose sufficient punishment to deter others, and promptly remedy program vulnerabilities.
Context: OIG-Department of Justice (DOJ) Strike Forces have responded swiftly and effectively to DME fraud schemes; CMS efforts to remedy program vulnerabilities are also essential.
The Affordable Care Act and Competitive Bidding
According to Levinson, the Affordable Care Act (ACA) “establishes new authorities and requirements to strengthen enrollment scrutiny, oversight, and response to address fraud vulnerabilities…including promoting data access and integrity; requiring actions to strengthen provider enrollment standards; promoting compliance with program requirements; and enhancing program oversight, including requiring greater reporting and transparency.”
Levinson believes that the CMS competitive bidding program is promising as a means to address fraud, waste, and abuse. He stresses, however, that other vulnerabilities continue to exist.
Editors note: To read the full testimony, visit www.oig.hhs.gov/testimony/docs/2010/testimony_levinson_09152010.pdf
