Medicare fraud costs the federal government millions of dollars a year. Fraudulent claims for devices used in home health care are among the costliest. As a result, Medicare is increasing regulation.
When a person has Medicare and needs a home health device, such as oxygen, they are supposed to receive a doctor's order for it and then get it from a supplier immediately. Most of the time that system works well for everyone involved.
However, fraudsters have been able to gain false patient and doctor identifications so they can file false claims and get paid.
In response, Medicare has been testing a pilot program in 19 states. In those states before a Medicare patient can receive a power wheelchair the doctor must first get approval from Medicare. How has the pilot program worked? Beginning on Feb. 28, the preapproval process will be expanded nationally. It will include other common home health devices, including oxygen and sleep apnea equipment.
The Pittsburgh Post-Gazette reported this story in "Medicare to tighten requirements for many home medical devices."
While it is good that Medicare is looking for ways to eliminate fraud, these new restrictions could have a negative impact on patients' health care. Some experts fear that requiring preapproval could lead to increased hospital stays while approval is sought.
For its part, Medicare claims it will respond to requests within 10 days and have a system in place to expedite review when necessary.
Reference: Pittsburgh Post-Gazette (Jan. 18, 2016) "Medicare to tighten requirements for many home medical devices."
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