Fraud detection operation examines durable medical equipment providers

An OIG Fraud Detection Operation (FDO) focused on indicators for potential fraud, waste and abuse among durable medical equipment (DME) providers. DME includes products like shower/bath chairs, incontinence supplies, blood pressure monitors and enteral feeding supplies. The FDO selected four providers based on the results of algorithms generated by the OIG’s data team, which looked for the following:

Clients who may not be receiving the required physician visits within six months prior to distribution of equipment or supplies.
High use of miscellaneous billing codes, which could indicate a provider is billing a higher amount for a product than is allowed or is billing for a product not allowed by Medicaid.
An FDO results from multiple OIG divisions reviewing and analyzing large volumes of data to identify providers that appear as statistical outliers among their peers. Through coordinated fieldwork and research, investigators evaluate additional evidence and information to determine if an outlier’s status is attributable to possible fraud, waste, abuse or program violation. Providers are required to supply records when requested by OIG investigators, make staff available for interviews and generally cooperate with the investigative operation. The record review for the four FDO-identified providers is still in process. Based on the review findings, these providers may be referred for a full investigation, allowing for a closer look at the providers’ billing and documentation patterns and other evidence.

To learn more about the OIG’s efforts to reduce fraud, waste and abuse, visit the OIG Featured News page.

Source: Fraud detection operation examines durable medical equipment providers / Inspector General Texas Health and Human Services

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