After Major Fraud Busts, Congress Questions Whether CMS is Fully Protecting Medicare

After several high profile home health care Medicare fraud schemes, the House Ways and Means Heath Subcommittee is asking the Centers for Medicare & Medicaid Services whether it’s doing everything it can to safeguard the program.

In a letter, the committee asks CMS for additional information regarding the agency’s efforts to identify “nominee owners” and the type of fraud perpetrated by those who run false storefronts and shell companies. The letter references a $20 million medicare fraud bust of a Miami Home Health Care Agency from March 2012 as evidence that CMS’s needs to do more.

“This indictment, along with the other examples cited in this letter, demonstrate that CMS’s provider screening efforts are still not effectively safeguarding the Medicare program from individuals intent on committing fraud within the Medicare program and that CMS should revise its screening efforts to address nominee owners.”

Those who operate as nominee owners does not identify themselves as an owner, but in fact exercises ownership and control of an entity.

“Thus far, it does not appear that CMS has addressed the concept of nominee owners, false storefronts, and shell companies in any of its enrollment regulations or its Provider Screening statement of work,” said the letter.

View a copy of the letter here.

Written by John Yedinak

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