Dead doctors may have received upwards of $100 million in fraudulent Medicare payments for the first 7 years of this decade. If this type of criminal billing continues at its current rate, it could chew up as much as 15 to 20 percent of the entire Medicare budget for 2008.
Senator Norm Coleman (R MN), a ranking member of the Permanent Subcommittee on Investigations is conducting investigations into these fraudulent billing practices and recently presented his alarming findings at a Senate hearing entitled “Medicare Vulnerabilities: Payments for Claims Tied to Deceased Doctors.” The hearing was set to examine Medicare payments for durable medical equipment (DME) where claims had doctor identification numbers assigned to physicians who had been dead for at least one year prior to the date on the billing.
“In short, the subcommittee’s investigation uncovered some appalling facts,” Senator Coleman said. “The subcommittee found that between 2000 and 2007, Medicare paid for hundreds of thousands of DME claims in which the prescribing doctor had died years earlier. The estimated payments for those claims could be up to $100 million.” Here are some classic cases of abuse pointed out by the Senator:
- A Florida doctor died in 1999. Since then, his identification has been used by 3 different organizations to file fraudulent claims. The committee identified at least $350,000 in claims, with estimates of up to $500,000.
- Another doctor passed away in 2001, and his ID number was used in over 3,800 claims totaling more than $354,000.
- Still another doctor was listed in some 2,000 claims at over $478,000.
Most alarming, according to the Senator, is that this issue of Medicare fraud was previously addressed with the Department of Health and Human Services in 2001. At that time, the paying agency – the Centers for Medicare and Medicaid Services (CMS) – agreed to work to fix the problem of paying dead doctors by April 2002. Apparently that has not occurred as 63 percent of the improper $100 million in payments were made after that date. The subcommittee investigation shows that thousands of doctors who passed away in the 1990s are still active.
Senator Coleman wants the system fixed and is calling on the CMS to get this done. He points out that the figure of $34 million made in improper payments in 2004 and 2005 would roughly total the size of the entire State of Minnesota general budget, all wasted on improper payments. As the Senator says, these are loopholes in the system that simply must be fixed and fixed now.
Source: Senator Norm Coleman of the Senate’s Permanent Subcommittee on Investigations. “Senator Coleman’s Opening Statement at PSI Medicaid Dead Doctors Hearing.” July 2009. http://coleman.senate.gov/public/index.cfm?FuseAction=PressReleases.Detail&PressRelease_id=08fe1b37-d0a0-d47b-160c-bcdfebf373ef
Source: Senator Norm Coleman of the Senate’s Permanent Subcommittee on Investigations. “Senator Coleman’s Opening Statement at PSI Medicaid Dead Doctors Hearing.” July 2009. http://coleman.senate.gov/public/index.cfm?FuseAction=PressReleases.Detail&PressRelease_id=08fe1b37-d0a0-d47b-160c-bcdfebf373ef
