OIG targets certifications of medical necessity
Here are a few examples of inappropriate or fraudulent certifications already uncovered by the Office of the Inspector General:
- A physician knowingly signs a number of forms provided by a home health agency that falsely represent that skilled nursing services are medically necessary in order to qualify the patient for home health services.
- A physician certifies that a patient is confined to the home and qualifies for home health services, even though the patient tells the physician that her only restrictions are due to arthritis in her hands, and she has no restrictions on her routine activities, such as grocery shopping.
- At the request of a DME supplier, a physician signs a stack of blank certificates for transcutaneous electrical nerve stimulator (TENS) units. The supplier later completes the certificates with false information in support of fraudulent claims for the equipment, which it submits to Medicare.
- A physician signs CMNs for respiratory medical equipment falsely representing that the equipment was medically necessary.
- A physician signs CMNs for wheelchairs and hospital beds without seeing the patients, then falsifies his medical charts to indicate that he or she treated them.
- A physician accepts from $50 to $400 from a DME supplier for each prescription he or she signs for oxygen concentrators and nebulizers.