CMS may suspend payments to a Medicare provider or supplier if there is evidence of fraud or willful misrepresentation; an overpayment exists, but the amount has not been determined; or payments made or to be made may be incorrect. CMS may also suspend payments based on requests from its contractors or from law enforcement.
The report reveals that CMS imposed 253 suspensions in 2007 and 2008, with Part B providers composing 86 percent of those suspensions. Overpayments to providers totaled at least $206 million. The report also suggests that a great majority of providers that CMS suspended in 2007 and 2008 exhibited characteristics of fraud. Other key findings from the report include:
• Seventy-four percent of suspended providers showed questionable billing patterns.
• Sixty-three percent of suspensions were supported by information from beneficiaries or other providers.
• Evidence showed some suspended providers had billed for services that were never rendered or were medically unnecessary and had used other providers’ billing numbers to receive payment.
Read the OIG report about payment suspensions (pdf).
Read other coverage about Medicare fraud:
– Prosecutors Seek 5-Year Sentence for Detroit Family Practitioner Accused of Medicare Fraud
– Los Angeles Physicians Charged for Roles in $5M Medicare Scam
– CHRISTUS Health in Houston to Pay $1M Settlement in Medicare Fraud Lawsuit
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