Unrestricted National Medicare Fraud Alert (UMFA 9802, issued June 9, 1998) REVISED October 6, 1998(Revisions are Shown in Italics): Billing for Services Not Rendered or Not Medically Necessary; Upcoding (Billing for Powered Wheelchairs and Delivering Power Operated Vehicles (POVs)); and Exchanging Power Wheelchairs for POVs After the Wheelchairs Were Paid. DME companies are utilizing three mechanisms to obtain inappropriate reimbursement for power vehicles, primarily for beneficiaries in Florida. The three mechanisms are: 1.They (the DME companies) bill for services not rendered or not medically necessary; or 2.They deliver a POV (scooter) and bill for a power wheelchair; or 3.They deliver and bill for a power wheelchair, and after receiving payment go back to the beneficiary and exchange it for a POV. The primary AK@ codes appearing were - K0011, K0021, K0031, K0034, K0067, K0073, K0081, and K0086. All these codes appeared in the beneficiaries= EOMBs. Codes E0192, E1399, and L0700 were billed in different combinations with the above AK@ codSource: www.hcfa.gov/medicare/fraud/9802A.HTMThese companies were submitting a large number of claims for CPT Code 93268 - transtelephonic arrhythmia monitoring test and for the following range of codes from 93270 - 93272, 93012-93014 and codes G0004-G0016. When 93268 is billed, 93270, 93271 and/or 93272 should not be billed. These companies were also under investigation for submitting fraudulent claims for surgical dressings and incontinence supplies. Contractors should look for the following: Claims for numerous beneficiaries residing at the same address. "Impossible date of service scenarios" such as a provider rendering volumes of services which seem potentially impossible. Doctors who work for the suppliers and beneficiaries that reside outside of the carrier jurisdiction. Doctors who make no other appearance in the beneficiaries histories other than being the ordering physicians on the IPL...
