Executive
Waste of the Day: Medicare Billers Cut Off
Doctor Mehmet Oz, now head of the Centers for Medicare and Medicaid Services, has cut off several billers for demonstrable fraud.
The Centers for Medicare & Medicaid Services announced it has cut off payments to 11 providers suspected of fraudulently billing $3.4 billion to Medicare Advantage for durable medical equipment in the past two years.
Examples of Medicare billing fraud
Key facts: A New Jersey-based provider claimed to have treated one patient 38 times, but records showed the patient died before the first treatment began.
A Texas-based provider also claimed to treat nine patients that records showed were already deceased. Another six people the provider claimed to treat told CMS they never heard of the company.
A company in Florida claimed to provide catheters to 1,277 patients in just two days.
CMS said it was able to stop $24 million from being sent to the 11 companies.
None of the companies were identified by name, and none of the payments have officially been confirmed as fraud. CMS has not announced any criminal charges.
Four of the providers were already banned from traditional Medicare but were still billing Medicare Advantage. A separate report also released in September found 50 such companies. Healthcare companies enrolling in traditional Medicare are supposed to undergo thorough screening, but Medicare Advantage — run by private companies — has looser requirements.
Medicare Advantage billing is harder to trace
Background: Traditional Medicare spends more than $7 billion per year on durable medical equipment like wheelchairs, canes and much more. But more than half of beneficiaries use Medicare Advantage, for which data is not publicly available.
CMS has made several statement about fraud prevention under Dr. Mehmet Oz, but it remains to be seen what the net impact will be. The agency made $96 billion in improper payments in fiscal year 2025, up from $87 billion in 2024. The fiscal year 2026 totals are expected in November.
Summary: Billing dead patients and people who never asked for equipment is as blatant as Medicare fraud gets.
The #WasteOfTheDay is brought to you by the forensic auditors at OpenTheBooks.com.
This article was originally published by RealClearInvestigations and made available via RealClearWire.
Jeremy Portnoy, former reporting intern at Open the Books, is now a full-fledged investigative journalist at that organization. With the death of founder Adam Andrzejewki, he has taken over the Waste of the Day column.
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