By: Michelle Duncan

Effective 02/02/09, the National Supplier Clearinghouse Medicare Administration Contractor (NSC-MAC) will begin performing fraud analyses of all current DMEPOS suppliers, initial applicants and  Medicare re-enrollment applicants.

DMEPOS suppliers will be assigned one of four fraud and abuse risk levels, ranging from low risk to high risk. The NSC-MAC will take the following seven factors into consideration, along with information from the OIG, CMS and/or a PSC when accessing a supplier’s risk level:

1. Experience as a DMEPOS supplier with other payers
2. Prior Medicare experience
3. Geographic location
4. Fraud potential of products and services provided
5. Site visit results
6. Inventory
7. Accreditation of the supplier

Review plans will be established for DMEPOS suppliers based on their risk levels and may include a set number of unscheduled site visits and/or maximum billing quotas a supplier must meet.

A supplier’s risk level will be updated on a yearly bases. Please click here for complete details from CMS (Chapter 10 of the Medicare Program Integrity Maunal).