Government watchdog warns of Medicare fraud after relaxing provider requirements

 A government watchdog agency is urging federal health regulators to speed up checks on providers and conduct background checks after raising concerns about the risk for fraud following the coronavirus pandemic.

The CMS relaxed provider enrollment requirements during the pandemic to ensure continuity for both providers and enrollees during the public health emergency. However, a report from the Government Accountability Office raised concerns about the fraud risk some of these providers may pose to the program.

The GAO found that about 222,000 providers were able to enroll between March 2020 and March 2022 through the relaxed requirements. Suppliers of durable medical equipment represented a small share of those who enrolled during this period but represented 83% of those who were later revoked from the Medicare program by the CMS.

“While this is not a large share of enrollments, even a small number of providers can cause significant financial harm if they commit fraud,” the GAO said in its report released Monday.

The GAO is recommending that the CMS conduct background checks on high-risk providers who enrolled during the public health emergency, speed up provider checks and evaluate its own performance to inform policies for future emergencies.

Florida, California and Texas were home to the largest number of durable medical equipment suppliers enrolled during the pandemic who were later revoked from the program.

The Medicare program is expected to spend roughly $940 billion on healthcare services for 65 million members in 2022, and the GAO estimates a total of $47 billion in improper payments.

https://www.healthcaredive.com/news/government-watchdog-gao-medicare-fraud-pandemic/639176/