CMS finalizes rule to curtail major DME fraud concerns

CMS finalizes rule to curtail major DME fraud concerns
McKnight's Home Care; by Adam Healy; 9/26/24
The Centers for Medicare & Medicaid Services finalized a rule this week that will help it better track anomalous and highly suspicious billing activity for durable medical equipment. The rule allows CMS to more closely monitor two Healthcare Common Procedure Coding System (HCPCS) billing codes for urinary catheters: A4352, an intermittent urinary catheter with a curved tip, and A4353, an intermittent urinary catheter with insertion supplies. These two billing codes were behind what may be the largest case of Medicare fraud in the program’s history. In February, the National Association of ACOs (NAACOS) uncovered evidence that fraudsters had used the two codes to loot as much as $3 billion or more from government health programs.