The Michigan Daily - michigandaily.com
Wednesday, September 24, 2008 - 7A
Probe: Medicare
billions in suspec
Some claims were
disbursed by using
blank, invalid codes
WASHINGTON (AP) - The
government paid more than $1
billion in questionable Medicare
claims for medical supplies that
showed little relation to a patient's
condition, including blood glu-
cose strips for sexual impotence
and special diabetic shoes for leg
amputees, congressional investi-
gators say.
Billions more in taxpayer dollars
may have been wasted over the last
decade because the government-
run health program for the elderly
and disabled paid out claims with
blank or invalid diagnosis codes,
such as a "?" or "zzzzz." Medicare
officials say even smiley-face icons
could have been accepted.
The report by Republicans
on the Senate Homeland Secu-
rity investigations subcommittee,
obtained by The Associated Press,
is the latest to detail lax oversight
in the $400 billion program that
has been cited by government
auditors as a high-risk for fraud
and waste for nearly 20 years.
The panel's review of millions
of claims submitted by sellers of
wheelchairs, drugs and other med-
ical supplies on behalf of Medicare
patients from 2001 to 2006 found
S at least $1 billion in which the
listed diagnosis code appeared to
have little, if any, connection to the
reimbursed medical item.
For example, blood glucose test
strips are almost exclusively used
for diabetics. But Medicare paid
millions of dollars to medical sup-
pliers for the test strips without
question based on non-diabetic
diagnoses ranging from typhoid
and bubonic plague to chronic air-
way obstruction and "psychosexu-
al dysfunction."
Other questionable claims
included wheelchairs or wheel-
chair accessories for patients list-
ed as having a deformed nose or
sprained wrist; special shoes for
diabetics or shoe inserts for those
with leg amputation or "preco-
cious sexual development"; and
walkers for people diagnosed with
paraplegia. '
"Since when did doctors start
prescribing blood glucose test
strips for the bubonic plague?"
Minnesota Sen. Norm Coleman,
the top Republican on the panel
said Tuesday. "CMS's review pro-
cess simply doesn't check to see
whether the claim makes sense
and that leaves Medicare vulnera-
ble to fraud, waste, and abuse. Bot-
tom line: we need to know where
our Medicare dollars are going."
The Senate report urged the
Centers for Medicare and Med-
icaid Services to consider new
procedures to prevent fraud by
reviewing whether diagnosis
codes are medically related to the
supplies being reimbursed, and to
reject claims with any invalid or
incorrect codes. Currently CMS
generally just checks to see if the
coding is listed in the proper for-
mat before making payment.
The Senate investigation was
conducted by both Democratic
and Republican committee staff.
Sen. Carl Levin, D-Mich., who
chairs the subcommittee, declined
to sign onto the final report, citing
lack of time for review due partly
to congressional efforts inthe Wall
Street bailout.
Responding in the report, CMS
saidithadtakensteps inrecentyears
to identify potential fraud and abuse,
such as creating warning flags in
the processing system for high-risk
items such as glucose strips.
CMS also argued it should not
be faulted for failing to review
Medicare claims prior to 2003 that
had questionable or invalid diag-
nosis codes. The agency contended
that even though diagnosis codes
had been widely used on forms
since 1991, federal regulations
were ambiguous until 2003 as to
whether the codes were actually
required to process a claim. As a
result, if claims forms had blanks,
question marks or even icons such
as a smiley face for the diagno-
sis code, they might have been
improper but they did not techni-
paid
t claims
cally bar payment, CMS said.
"This report highlights a vul-
nerability that we addressed five
years ago related to our review of
claims for medical services and
supplies," CMS spokesman Jeff
Nelligan said Tuesday. "CMS has
always used clinical information,
including diagnosis codes, to tar-
get certain vulnerable and high
risk claims." He said that CMS has
validated diagnosis codes on all
medical equipment claims since
2003. ,
Investigators, however, noted
CMS has pledged for many years
to fix problems with little success.
For example, CMS put flags in
its system to help check diagnosis
codes listed in claims for glucose
strips in response to a June 2000
report by the Health and Human
Services Department's inspec-
tor general that warned of the
potential for fraud. Yet the Senate
investigation found that despite
reforms, CMS in 2006 still paid
$535,032 for glucose strips with
the highly questionable diagnosis
of chronic airway obstruction -
an amount roughly equivalent to
the $526,059 paid in 2001 for the
same cited diagnosis.
Other findings:
-Medicare paid suppliers with
little question after the suppli-
ers submitted claims forms with
blank or otherwise invalid diag-
nosis codes. Roughly $4.8 billion
in payments were made from 1995
to 2006 despite invalid coding or
nothinglisted at all; about $23 mil-
lion of that amount was paid after
2003, when federal rules- made
clear the codes were required.
Based on a sample of 2,000
of those invalid coding claims,
investigators found more than 30
percent could not be verified as
legitimate and "bore characteris-
tics of fraudulent activity," such as
doctors who were actually dead,
retired or who denied authorizing
the treatment or making the diag-
nosis.
-The CMS contractor responsi-
ble for analyzing Medicare claims
data maintained information that
was incorrect and out of date.
DPS
From Page1A
area was not under the jurisdiction
of DPS, and therefore the respon-
sibility of the Ann Arbor Police,
Wilson responded with her plan to
address increased crime in general.
Wilson responded with the
"three E's": engineering, including
repairing streetlights; education
such as making students aware of
crime occurring around campus
and making sure they report it
quickly; and enforcement.
Wilson made no effort to act as if
she had all the answers to the Uni-
versity's crime situation.
"I think it's somewhat arro-
gant to come in and say 'This is
what needs to be done' as a new
director," she said. "Maybe things
are OK and nothing needs to be
changed."
Zaikis said she like Wilson's pro-
fessional and modest approach.
"I think she's great," Zaikis said.
"It's refreshing to have such a per-
sonable candidate as chief of DPS. I
was very impressed."
Stacy Johnson, human resourc-
es official for Facilities and Opera-
tions and a member of the search
committee, said there was not a
yet a timeline for the decision, but
added the search will move for-
ward when the committee recon-
venes in two weeks.
MESSAGES
From Page 1A
than dirty campaigning and fear
tactics; not representative of the
caliber of dialogue we expect at
the University of Michigan," they
wrote.
Styer drafted the letter after see-
ing the messages Monday. He then
called Smith and they agreed it was
important to take action.
"We're taking a united stand
against this kind of campaigning on
campus," Styer said in an interview.
Smithsaidthe College Republicans
weren't involved inthe incident.
"We've run a good, clean, posi-
tive campaign on both sides lead-
ing up to this point, and we'd like
to continue that," said Smith, who
said he never saw the chalkings.
"We're very excited by everyone's
passionate civic engagement and
we'd just like to make sure that
it's on a completely constructive
level, like most of the (positive)
comments that were written."
The question of what is appro-
priate in the race for the presidency
has been analyzed on a national
level for months, but has become
more local as Election Day draws
nearer.
A week ago, an Obama billboard
was vandalized on the US-23 High-
way near Ann Arbor. The sign was
defaced with racial slurs in black
spraypaint, swastikas, the letters
"KKK" and drawings of Ku Klux
Klan hoods.
Obama, the first-ever black
presidential nominee from a major
party, has also been the target of
several recent threats. The Secret
Service is investigating threaten-
ing letters against Obama that
were received separately in Liv-
ingston County.
Both Styer and Smith stressed
the importance of working togeth-
er to set a positive tone on campus
leading up to the election. Their
letter focused on the necessity of
making campaign education events
a collaborative effort.
"This election is far too crucial
to be denigrated by dishonesty and
hysterics," they wrote. "Let us work
together to strengthen America
through a respectful, issue-oriented
campaign."
Get involved while you're Freshmen.
Pick from a Bushel of Opportunities.
Check out what
Campus and Ann Arbor
have to offer in the
Campus Involvement Page
Published Thurs. Sept. 25
Finnish gunman kills 10, had
made violent YouTube videos
Rampage bears
similarity to 2007
massacre in which 8
were killed
KAUHAJOKI, Finland (AP)
- A chilling YouTube video
with a young man firing a pis-
tol and warning "You will die
next" caught the eye of police,
who questioned him but then let
him go, saying they didn't have
enough evidence to take away his
weapon.
On Tuesday, he walked into a
vocational college, the School of
Hospitality, and opened fire, kill-
ing 10 people and burning their
bodies with firebombs before
shooting himself fatally in the
head. At least two other people
were wounded.
The rampage bore eerie simi-
larities to another school massa-
cre in Finland last year in which
an 18-year-old gunman killed
eight people and himself. Both
gunmen posted violent clips on
- YouTube prior to the shootings,
both were fascinated by the 1999
MINISTER
From Page 1A
said. "It's possible to do both, but
a lot of students choose to go after
just the career."
A large group gathered around
Smock, who compared Demo-
cratic presidential nominee Barack
Obama to Robin Hood and said civil
rights leader and nonviolence ad-
vocate Mahatma Gandhi deserved
to go to hell because he wasn't a
Christian.
"Obama's a socialist," Smock
said, referring to Obama's univer-
sal health care proposal. "He's for
stealing. Thou shall not steal. I be-
* lieve you should help the poor, but
if someone doesn't want to, the gov-
ernment shouldn't force them to."
Hundreds of passersby came
to a standstill when they caught a
glimpse of Smock's signs, which
read "Jesus Hates Sin" and "Jesus
Loves Righteousness."
Smock's message didn't fare
well with students, many of whom
encircled the suspenders-clad
preacher for hours.
"I'm just amazed by what he's
saying," said Margaret Bauer, a Ki-
nesiology freshman who looked
Columbine school shootings in
Colorado, both attacked their
own schools and both died after
shooting themselves in the head.
The latest shootingraised ques-
tions about whether police could
have stopped the bloodshed, and
although there was little initial
debate about gun control, Prime
Minister Matti Vanhanen said the
government may consider restric-
tions on privately held semiauto-
matic weapons.
There are roughly 1.6 million
firearms in private hands in Fin-
land, a nation with deep-rooted
traditions of hunting in the sub-
Arctic wilderness. The country's
650,000 licensed gun owners -
about 13 percent of the population
of 5.2 million - include hunters,
target shooters and gun collec-
tors, and Finland ranks in the
top five in civilian gun ownership
per capita along with the United
States, Yemen, Iraq and Switzer-
land.
Finnish media identified the
gunman as Matti Juhani Saari, a
22-year-old student at the school,
which offers courses in catering,
tourism, nursing and home eco-
nomics. Police declined to iden-
tify him, saying he did not have a
previous criminal record.
Witnesses said panic erupted
as the masked gunman, dressed
in black and carrying a large bag,
entered the school just before 11
a.m., and started firing in a class-
room where students were taking
an exam.
"I heard several dozen rounds
of shots, in other words it was an
automatic pistol," school janitor
Jukka Forsberg told broadcaster
YLE. "I saw some female students,
who were wailing and moaning
and one managed to escape out
the back door."
About 150 students were
inside the school, 180 miles
northwest of Helsinki, when the
shooting began. Students and
teachers were evacuated - some
reportedly fleeing down a near-
by river in row boats - as police
arrived.
Jari Neulaniemi, the officer
heading the investigation, said
the attacker was armed with a
.22-caliber pistol and firebombs
that were used to start several
fires. Many of the bodies in the
school were burned beyond rec-
ognition, he said.
shocked while standing on the
Diag. "Religion is a personal thing,
and everybody should have respect
for everybody, no matter what they
believe'
LSA senior Alex Kostrzewa
mocked Smock and stood next
to him, shouting the opposite of
whatever the minister said. After
Smock said everyone should wor-
ship his God, Kostrzewa shouted,
"Don't worship his lame-ass God!
We should just all die for the glory
of battle!"
Rather thanretaliating, the salt-
and-pepper-haired Smock took a
sip of his bottled water whenever
he grew frustrated with Kostrze-
wa.
A fight nearly broke out lastyear,
when fellow evangelist preacher
Michael Venyah told hundreds of
students the Pope was going to
hell.
Smock, who said he has spent the
last 34 years spreading his message
across the country, garnered sparse
support during his talk. Ann Arbor
resident Devin Baker said he was
simply taking a walk through the
Diag when he heard Smock speak-
ing.
"I think he's right-on," said
Baker, adding he thought students
would eventually come to agree
with Smock.
For now, though, most students
seemed to take Smock's visit as a
joke.
"I just find it funny,"LSA sopho-
more Richard Boehnke said as
Smock waved an index finger at on-
lookers. "This sort of thing makes
me happy."
Voice Your Vote organizer Han-
nah Lieberman, an LSA junior,
called Smock's decision to speak
next to a voter registration booth
"advantageous:' She said the move
helped her group register more vot-
ers.
"He's a distraction, but he draws
a huge crowd and fires people up,"
she said. "If he weren't here, a lot
of people probably would walk past
without noticing us."
Around 3 p.m., the crowd sur-
rounding Smock-became a handful
of people looking to respectfully
challenge the minister's beliefs.
one person asked him if it.was right
to judge people.
"Not if it's a hypocritical judg-
ment," said Smock, citing the sev-
enth chapter of Matthew in the
Bible. "But if it's a righteous judg-
ment, there's nothing wrong with
that."