By Staff
Medicare is a critically important program that provides essential health care to many folks across the country. But a recent investigation by my Permanent Subcommittee on Investigations uncovered unacceptable abuses in Medicare: payments in the name of deceased doctors.
How is that possible? From 2000 to 2007, we estimate that nearly half a million payments, totaling about $76 million, went to durable medical equipment suppliers that had submitted claims using the identification numbers of 17,000 deceased doctors.
The Subcommittee reviewed a list of physicians who died between 1992 and 2002, and found more than 33,000 deceased physicians who had Medicare physician identification numbers. From that list, we created a small sample and then closely reviewed Medicare claims data for claims that occurred more than a year after the deaths of those physicians.
We found, for example, a physician in Florida who died in 1999. Six to seven years later, from November 2005 through November 2006, Medicare paid out over $544,000 worth of durable medical equipment claims supposedly ordered by this physician.
How is it possible that Medicare paid over half a million dollars for durable medical equipment presumably ordered by a deceased physician 6 to 7 years after his death? The Centers for Medicare and Medicaid Services (CMS) failed to adequately monitor and audit their contractors who are paid to update the identification numbers used to keep track of physicians and to process claims for durable medical equipment.
These paid contractors are supposed to verify that the claim includes a valid and active Unique Physician Identification Number (UPIN) for the prescribing physician. If the number does not exist, or if it is assigned to a physician that is deceased, the claim should not be paid. It is supposed to be that simple.
Instead, in the Florida case and others across the country, contractors accepted claims using the deceased doctor's identification numbers. We estimate that about 2500 deceased physicians still had active identification numbers as of May of this year.
What makes matters worse is that Medicare administrators were alerted to this problem back in 2001, and said they took steps to correct it. A report at that time found over $90 million had been paid for durable medical equipment and supply claims with invalid or inactive physician identification numbers in 1999 alone. But Medicare administrators never re-evaluated the situation to ensure the problem was fixed, and apparently neither they nor their contractors did what they were supposed to do.
The failure to stop payment of deceased physician claims is inexcusable since dates of deaths are so readily available and appear on the CMS' own records. This type of abuse should have been stopped long ago. It is easy to obtain deceased physicians' identification numbers, and easy to use those numbers to obtain payouts through fraudulent claims. As long as millions of dollars in claims with deceased provider identification numbers are paid, fraudsters will continue to rip off the system.
At our hearing we asked these administrators tough questions, pressing them as hard as we can to end this taxpayer rip-off. The Centers for Medicare and Medicaid Services promised to immediately correct this problem so that we will not be asking the same questions – and continuing this outrageous abuse of taxpayer dollars – in the years ahead. We will keep the heat and the light on to make sure they do just that.