Because of the provision, Medicare claims-processing systems do not need to verify equipment was actually ordered by an eligible physician. CMS has paid $87 million in claims lacking physician provider numbers over 16 months, according to the OIG report. While the report did not examine if the claims were actually fraudulent, it did discover that many of these claims covered categories of equipment with significant fraud activity. As a result, the OIG recommends that CMS end the practice as soon as possible, while maintaining access to this equipment for beneficiaries, according to the report.
CMS has required suppliers to list their NPI along with the physician’s NPI on all claims since May 2008. However, because of difficulty some suppliers have in obtaining physician NPIs, CMS allowed them to use their NPI twice to processes a claim. Suppliers claim the provision ensures timely claims processing.
This temporary provision is set to expire in Jan. 2011, but has already been postponed twice before.
According to the OIG, CMS should begin enforcing the use of physician NPIs in order to reduce any fraudulent claims are paid.
Read the AMedNews’ report on Medicare fraud risk.
