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Former Medical Director Speaks Out About Medicare Fraud
Date:2/11/2009

LOUDON, Tenn., Feb. 11 /PRNewswire/ -- Dr. Doran Edwards is the former Medical Director of the Statistical Analysis Durable Medical Equipment Regional Carrier (SADMERC), the division of Medicare that oversaw durable medical equipment until August of 2008. He believes that Medicare is an outstanding program that truly can help reduce the cost of our nation's healthcare by preventing and or transferring medical expenses to the less costly home environment. Unfortunately, the prevalence of fraud in the Medicare system has been so great that SADMERC determined in some categories as much as 40% of the funds spent annually on durable medical equipment and prosthetic devices (DMEPOS) were paid directly to fraudulent suppliers. Some DMEPOS manufacturers have contributed to the problem by outsourcing production, reducing standards and lowering quality in order to maximize profits.

CMS is clearly addressing fraud with new provider accreditation requirements that go into effect this year, but the issue of abuse by companies who make and market defective equipment is not being dealt with as urgently as it is needed. In a few years there will be a 3 to 4 fold increase in Baby Boomers of Medicare age. Without definitive action, the Medicare Trust Fund could be depleted as early as 2012 or as late as 2020. If action is not taken now, we may not have the opportunity to realize the true potential of the unparalleled healthcare delivery system that Medicare represents.

Medicare can save billions in healthcare cost every year by closing coding loopholes that allow inferior and unregulated products to be sold as if they were approved "durable medical equipment". CMS contractors and law enforcement agencies need greater authority and the resources to crack down on deceptive marketing practices, adulterated products, false claims made by manufacturers and fraudulent suppliers. Unfortunately, Medicare's current product appr
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SOURCE Advanced Healthcare Consulting
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