Fraud & the Stark Law

CMS previously acknowledged that increased physician involvement will reduce waste, fraud and abuse in the provision of DME, which has been an ongoing problem. In the 2013 Physician Fee Schedule, CMS noted…

“We believe that increasing physician involvement will help limit waste, fraud, and abuse while encouraging beneficiaries to maintain access to the necessary services. We believe physician involvement will not only assist in reducing waste, fraud and abuse but it will also help to ensure that beneficiaries receive high quality DME to meet their specific needs.”

Audits reported by the four DME MACs reflect PAP error rates as high as 80%.

In some cases, the patient’s record does not even confirm delivery of the equipment, and additional documentation errors arise from lack of communication between the sleep center and DME supplier. Coordinated care provided by sleep medicine physicians will minimize payment and administrative errors, providing the cost effective, quality care that American Medicare patients deserve.

For all questions, comments, and opportunities for collaboration, please contact AASM advocacy staff ( at (630) 737-9700.