Medicare database plagued by flaws

[Omaha Steve]

Source: Omaha World Herald

By Matt Wynn

At least 28 doctors received reimbursements from Medicare in 2012 while listing Nebraska addresses, even though they weren't licensed to practice in the state at the time, The World-Herald has found.

Many of the doctors appear to have left the state to practice elsewhere. All let their Nebraska licenses lapse, some as far back as 2004.

Among them is a kidney doctor who received third-largest reimbursement among the state's physicians. All told, Medicare paid the 28 doctors a combined $4 million, according to an analysis of the payment data.

The flaws don't indicate fraud, but they may have some impact on Medicare costs. Reimbursements are adjusted based on location, so inaccurate locations could alter payouts.

FULL story at link.


Read more: http://www.omaha.com/article/20140423/LIVEWELL26/140429572#medicare-database-plagued-by-flaws

[DeeDeeNY]

1. The doctors can do well on Medicare nationwide

http://nypost.com/2014/04/09/medicare-paid-doctor-21m/

[JimDandy]

2. Are Nebraska reimbursements higher

than at the locations where the doctors now live? The article never even goes there after alluding to the possibility of reimbursement fraud based on that. We need more Edward R Murrows in the media.

[pipoman]

3. CMS identified this problem

Some time ago. This is why they required every doctor in the US to be re-credentialed beginning in October of 2013. The procedure for re-credentialing is rife with issues, from inability to access the database because nobody knows the login that was used 10 years ago to credential and there is no easy way to determine that and the system won't allow for re registering, to doctors who work for numerous facilities only receiving one notification to re credential at one location resulting in denial of payments to all of the other facilities. No, Medicare is screwed up, CMS is screwed up, some doctors are unknowingly in violation, some doctors are intentionally defrauding medicare.