Connecticut medical supply company suspended from Mecicaid program due to fraudulent claims

CCH® Medicaid — 10/3/08

State fraud penalties imposed against DME provider, owner
The Supreme Court of Connecticut upheld the state agency's imposition of $178,053.28 in restitution and a five-year suspension from the Medicaid program for overpayments and fraudulent claims by a provider of oxygen equipment and supplies and an individual owner. The state agency terminated the supplier's provider agreement after determining that 74 percent of the supplier's audited claims had been overpaid and that some of the overpaid claims were based on altered documents.

The evidence of misconduct

The auditor randomly selected 93 of the 3,496 claims filed by the supplier during the two-year period of the audit. Of those, 69 contained at least one of 16 irregularities that resulted in overpayments, including failure to have a certificate of medical necessity on file, claiming payment for more oxygen than was authorized, overlapping dates of service, use of billing codes inconsistent with the documented services, and alteration of documents. The supplier's response to the termination notice admitted errors and sloppy bookkeeping but denied knowledge of any alterations of documents. Extrapolating from the 93 audit claims, the agency determined that the supplier had been overpaid $261,303.45. It offset $83,025.17 from funds owed to the supplier.

Read the rest of the story here: http://health.cch.com/news/medicaid/100308a.asp