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The U.S. Senate Committee on Homeland Security and Governmental Affairs, Permanent Subcommittee on Investigations' recent hearing on fraud, waste, and abuse in the Medicare program has found a pattern of claims containing the physician identification numbers of doctors who had died at least one year before the prescription was filled. The hearing focused on Durable Medical Equipment (DME) claims citing a deceased doctor as the prescribing physician, and inadequate oversight by the Centers for Medicare and Medicaid Services (CMS) to correct the problem. The Subcommittee also issued a Subcommittee staff report in conjunction with the hearing summarizing its investigative findings.

For its study, the Subcommittee selected a statistically valid random sample of 1,500 physicians from a list provided by the American Medical Association, of 33,000 deceased physicians with assigned UPINs. According to the staff report estimation, from 2000 through 2007, Medicare paid for approximately 478,500 claims that contained the Unique Physician Identification Numbers (UPINs) of deceased doctors, and the number of claims paid could be as high as 570,000. Sixteen percent of those claims, valued at around $4 million, are from UPINs of doctors who died ten years or more before the service date on the claims. The report also estimated that the amount of money paid for these claims is well over $76.6 million, and possibly that that number actually exceeding $92 million. The number of deceased physicians UPINs is between 16,500 and 18,200. In one case study examining claims in Florida, one UPIN was used in 484 claims, totaling more than $544,000, from a doctor who had been deceased six years.

In 2002, practices were instituted at CMS including a one-time UPIN review and elimination, de-activation of UPINs of deceased physicians or those who have not filed a claim for twelve months, and directing claims processing contractors to reject claims with invalid or inactive UPINs. However, in spite of these practices, suspect claims continued to be accepted. According to the staff report neither CMS, the HHS/OIG, nor the claims processing contractors performed the reviews or audits needed to ensure that the 2002 practices were effective in stopping the payment of deceased physician claims, resulting in tens of millions of dollars in improper payments.

The report recommends that procedures should be strengthened to deactivate National Provider Identifiers (NPIs) after a physician's death; regular NPI registry and claim audits; and consideration of additional measures to strengthen the registry.

Included in the report is a response letter from Herb Kuhn, Deputy Administrator for CMS. Mr. Kuhn states that CMS is engaging in a data-matching program with the Social Security Administration Date of Death with its NPI and provider enrollment database to be implemented later this year, along with other proposed measures.

In the hearing, Committee member Sen. Carl Levin (D-MI) stated, "The failure to stop payment of deceased physician claims is inexcusable since dates of deaths are so readily available...As long as millions of dollars in claims with deceased provider identification numbers are paid, fraudsters will continue to rip off the system."

Ranking member Sen. Norm Coleman (R-MN) stated, "Not only should we fix the system to prevent improper payments, but our law enforcement agencies should also go after the fraudulent actors who steal from all of us using false information. They are literally exploiting the demise of honorable physicians to rip off the American people and they should be prosecuted."

The report and testimony can be accessed at: http://hsgac.senate.gov/public/index.cfm?Fuseaction=Hearings.Detail&HearingID=eb856347-01f1-4b55-826e-a9bf5247072c