Medicare fraud report results rejected by inspector general's report

A report by the Office of Inspector General, due to be publicly released within the next week, challenges Medicare's figures relating to fraud. AdvanceMed, the company hired by Medicare to audit fraud, submitted a report that is being challenged by the inspector general's office. Some say AdvanceMed itself may be investigated.

The Office of Inspector General’s report details scrutiny of a program known as Comprehensive Error Rate Testing, or CERT, that audits a sample of Medicare claims submitted by sellers of durable medical equipment. That program is supposed to randomly choose claims and review the medical records and other documents supporting submitted claims to determine whether payment is justified.

According to the inspector general’s report, officials at Medicare instructed AdvanceMed to disregard those policies. Instead, AdvanceMed was told to examine only the documents submitted by the companies selling the medical equipment, rather than verify those documents against physicians’ records.

Medicare reported to Congress that, for the fiscal year of 2006, AdvanceMed’s investigations had found that only 7.5 percent of claims paid by Medicare were not supported by appropriate documentation. But the inspector general’s review indicated that the actual error rate was closer to 31.5 percent. via NY Times.com