One of the changes during the worldwide pandemic was the Centers for Medicare & Medicaid Services (CMS) relaxing provider enrollment requirements. The shift occurred due to the coronavirus pandemic that created the need to provide much-needed continuity for providers and enrollees as a public health emergency spread through the U.S. and the world.
The Government Accountability Office (GAO) is sounding the alarm over the greater possibility of fraud following the pandemic. Officials discovered approximately 222,000 providers enrolled from March 2020 to March 2022, when the relaxed requirements were in effect. They are now urging federal health regulators to increase checks on providers.
A troubling trend
Of particular interest are durable medical equipment suppliers that composed a small number of enrollees to the Medicare program while also accounting for 83 percent that was subsequently revoked from the program by the CMS. Florida, California, and Texas composed the top three states with these enrolled suppliers.
In response to that alarming disparity, the GAO is encouraging background checks on high-risk providers, increasing the pace of provider checks, and evaluating their ability to inform policies should another health emergency arise.
The growing problem is occurring in the shadow of Medicare predicted to spend more than $900 billion on healthcare services for 65 million members in 2022. The GAO is predicting that $47 billion will go out in improper payments.
While a small segment took advantage of the generosity of a program meant to help those suffering during a worldwide health crisis, a majority of providers conducted themselves honorably throughout the pandemic.