Medicare Billing Under Investigation

Medicare billing of durable medical equipment is under investigation - and results show that billions have been spent on claims with questionable diagnostic codes. According to USA Today, these diagnostic codes should correspond to the condition for which the equipment is prescribed, but a recent report shows that some medical equipment is being provided even if the diagnostic code is for an unrelated condition. For example, Medicare has paid for walkers for individuals with a diagnostic code for sinus congestion.

It is possible in at least some of the cases that the items are truly medically necessary, but the incorrect diagnostic codes are being furnished - in fact, the report found some cases where the space for the diagnostic code was filled in with smiley faces. However, it is also likely that in at least some of the cases, Medicare is paying for unnecessary medical equipment.