In written testimony, Odelugo offered several explanations for why the DME payment system is vulnerable to fraud:
- marketers and providers can submit claims for reimbursement based on forged prescriptions;
- multiple billing codes for similar items make it possible to avoid Medicare’s red flags;
- unique physician identifiers are too easily accessible to the public; and
- the reimbursement system encourages abuse.
Odelugo recommended setting up a one- to two-year probationary period that would require any DME provider to be bonded by an independent bonding company. Imposing the requirement would “weed out” those looking to make a quick buck off the system, he said.