Anonymous-DC

In this proposed rule, CMS states that, “Accordingly, our proposal to revise 42 CFR 424.540(a) would remove this unnecessary burden without jeopardizing our ability to detect and prevent fraud and abuse.” This statement is incorrect. As the Office of Inspector General (OIG) has pointed in several reports, including OEI-03-01-00270 and OEI-04-08-00470, the Medicare program remain vulnerable to fraud when surrogate practitioner numbers are used on a Medicare claim. Further, in OEI-04-08-00470, the OIG recommended that CMS implement claims-processing system changes to ensure that NPIs for both referring physicians and suppliers be listed on medical equipment and supply claims are valid and active; emphasize to suppliers the importance of using accurate NPIs for both referring physicians and suppliers when submitting Medicare claims; and determine the earliest date to end the provision that allows suppliers to submit claims without referring physician NPIs while maintaining beneficiary access to services. By allowing unused Medicare billing numbers to remain active, CMS is fundamentally increasing the risk of fraud, waste and abuse in the Medicare program. Accordingly, I recommend that CMS explain why it believes that allowing unused individual practitioner Medicare billing numbers to remain active indefinitely will not increase Medicare exposure to fraud, waste and abuse when a provider/supplier (e.g., home health agency/clinical lab, durable medical equipment company or independent diagnostic testing facility) submits a claim for a physician or eligible non-physician practitioner who has not billed the Medicare program in more than year.