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Medicare pushes new payment rule after alleged $3 billion fraud scheme

"We've never seen anything like this" in size and scope, said one industry leader.

Federal officials are seeking to overhaul how Medicare pays health-care providers after an alleged $3 billion scheme to defraud the program, which would be one of the largest such schemes in its history.

For more than a year, officials said, about a dozen companies submitted bills to the Centers for Medicare and Medicaid Services for tens of millions of urinary catheters, using the personal information of Medicare beneficiaries and physicians - some of whom still have questions about how the companies obtained their private details and used them to bill the federal health program for catheters that they never wanted nor received.

Experts said the alleged catheter fraud ring is just the latest reminder that Medicare is a tempting target for scammers. The roughly $1 trillion agency has long struggled to combat a stream of fraudulent claims for durable medical equipment, and CMS leaders have urged Congress to provide them with additional resources to crack down on would-be thieves.


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