Each year, bad actors defraud Medicare and taxpayers of millions of dollars by billing for durable medical equipment that enrollees do not need or never receive. Despite efforts to combat this fraud, bad actors continually devise new schemes. Bold action is needed to address the underlying problems that allow durable medical equipment fraud to persist.
CMS has recently taken steps to increase its fraud-fighting efforts. For example, CMS has created a new Fraud Defense Operations Center to more proactively identify suspect billing and suspend payments. However, given the extent of durable medical equipment fraud in Medicare and the continuously evolving nature of durable medical equipment fraud schemes, more specific attention is needed to understand and prevent this type of fraud.
This white paper presents actions that CMS and others can take to stop bad actors from exploiting…
HOW TO SPOT A “RED FLAG” (THE BEHAVIORAL AUDIT)
Keep an eye out for these behavioral shifts in your staff:
Refusal to take leave: Afraid someone will find their “adjustments.”
Unexplained wealth: Buying luxury items that don’t match their known salary.
Working odd hours: Preferring to work alone late at night when no one is watching the system.
“Gatekeeper” behavior: Becoming overly defensive or angry when someone asks to see their records.