Medicare Vulnerabilities: The Use of Diagnosis Codes in DME Claims

Publication

Medicare Vulnerabilities: The Use of Diagnosis Codes in DME Claims

Abstract

From the Senate Committee on Homeland Security and Governmental Affairs, the Permanent Subcommittee on Investigations conducted an investigation into fraud, waste, and abuse in the Medicare program. This Minority Staff report focuses on the diagnosis codes on durable medical equipment (DME) claims, as well as the effectiveness of the Centers for Medicare & Medicaid Services (CMS) use of the codes. The investigation uncovered inconsistent rules governing the use of Diagnosis codes on DME claims, that Medicare has not been effectively utilizing these codes in the claims review process, and millions of claims had incorrect and outdated data.