Government Report Cites Shortfalls in Medicare’s Screening Process for Doctors

Thousands of doctors who bill Medicare used questionable addresses, GAO report finds

By Christopher Weaver of the WSJ. Excerpts:

"Thousands of medical providers signed up to bill Medicare using questionable addresses, and dozens of doctors enrolled despite disciplinary actions by state medical boards, according to a congressional probe of the $600 billion-a-year taxpayer-funded program.

Medicare records listed doctors and other providers as practicing at invalid addresses, such as commercial mailbox stores, construction sites and, in one case, a fast-food restaurant, according to a report by the Government Accountability Office that examined data through March 2013.

Over the past five years, the federal Centers for Medicare and Medicaid Services, which runs Medicare, has been revamping its enrollment system and verifying provider information, such as addresses and licensure. The overhaul is partly due to requirements of the 2010 Affordable Care Act. The CMS said Tuesday that as a result of its enhanced screening efforts, it has kicked more than 34,000 providers out of the program since February 2011.

The GAO says that some screening problems persist, however, among the 1.8 million providers enrolled to bill Medicare from nearly a million addresses. The report estimated that about 23,400 addresses might be invalid."

"It isn’t clear how much Medicare has paid out to providers whose addresses have been shown to be invalid. The agency estimates that overall, it made $44.2 billion in improper overpayments to medical providers in the fiscal year ended Sept. 30, 2014—a figure that includes payments to ineligible providers, for services that aren’t covered and duplicate payments, among other things."