CMS paying 6,000-plus doctors bearing ‘credentials’ from defunct medical schools—but it’s not as bad as it looks
In order to bill Medicare—in fact, just to be eligible to practice medicine—a physician must hold a degree from an accredited medical school. Yet Medicare’s provider database contains the names of more than 6,000 doctors whose credentials trace to medical schools that have been out of business for decades.
The jarring revelation comes by way of a July 30 MedPage Today/Vice News analysis.
MedPage/Vice points out that the shortcomings in oversight open Medicare to fraud, especially since CMS in 2014 reduced the amount of independent verification work its contractors perform.
The investigative journalism follows in the wake of the July 21 publication by the U.S. Government Accountability Office of a report showing that nearly a quarter of practice location addresses are “potentially ineligible.”
According to the GAO report, CMS estimates that $60 billion of the $554 billion it paid out in 2014 was “paid improperly.”
Of course, a defunct school listing is not necessarily an indicator of foul play.
The MedPage/Vice team looked into a few hundred doctors linked to the most dubious schools—the ones with fewer than 50 graduates in the database—and found every one of these docs to be properly licensed in his or her state.
It turns out that, if the correct school is not in a drop-down menu in the database, called PECOS for Provider Enrollment, Chain and Ownership System, the doctor goes with “Other.”
Medicare then “uses this information to verify that doctors and other providers have the proper education/certification for the specific provider type they are enrolling for in the Medicare program,” CMS officials told MedPage/Vice.
“It is no surprise with a system as large and complex as that administered by CMS that there are some data errors,” Matthew Shepard, a spokesman for the nonprofit Center for Medicare Advocacy, told the team.
“We just hope that, when found, these errors are remedied quickly and accurately, and cause no access issues for, or harm to, those who rely on the programs.”
Click here for the full article and here for the GAO report.
Dave P. has worked in journalism, marketing and public relations for more than 30 years, frequently concentrating on hospitals, healthcare technology and Catholic communications. He has also specialized in fundraising communications, ghostwriting for CEOs of local, national and global charities, nonprofits and foundations.