Medicare fraud can be large-scale, and even obvious fraudulent claims can be paid out by Medicare contractors for a long time.
We expected this: the WSJ headlines that DOGE has been let loose to search Medicare records for suspicious claims and payments. Anna Wilde Mathews & Liz Essley Whyte report. So far, DOGE has access to some CMS systems and not others.
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Also Washington Post, Bloomberg.
##Going back several years, Medicare had colossal abusive payments under gene sequencing code 81408 (billed in pairs on the elderly for $4000, plus related codes 81406, 81407). It took a long time for CMS to catch on, it should have taken a quarter or two. Damage? A billion dollars. See OIG report (which only skims the real story, July 2023) - here. I wrote about the same story several years before the OIG - back in September 2000 - here.
More recently, JAMA raised concerns for abuse of molecular microbiology codes (here), and CMS has official, but complicated, and perhaps poorly enforced, rules about gene code stacking versus use of code 81479 (Medicare policy manual). Any or all of these could be quirkly found by DOGE.
We discussed possible future DOGE use of MolDx rules in a January 1 blog.
