“Dive Brief:
CMS Medicare Advantage encounter data largely lacks National Provider Identifiers (NPIs) – an essential tool for safeguarding fraud — for providers who order certain equipment, according to a report from the HHS Office of Inspector General.
Unlike Medicare fee-for-service programs, MA programs aren’t required by CMS to submit NPIs for ordering providers on records for durable medical equipment, prosthetics, orthotics and supplies (DMEPOS) and for laboratory, imaging and home health services, though almost all have the ability to do so, the report posted Tuesday concluded.
OIG found 60% of the 2018 MA encounter records for DMEPOS and for laboratory, imaging and home health services were missing an NPI for an ordering provider. The watchdog recommends CMS require Medicare Advantage organizations (MAOs) to submit ordering provider NPIs for these types of items and services. CMS said it agreed with the recommendation in its response to the report…”
“Dive Brief:
MA fraud is not uncommon…” Read the full article here.
Source: MA encounter data lack essential information for fraud protection: OIG report – By Hailey Mensik, August 26, 2020. Healthcare Dive.
