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(b) Background on Significant, Anomalous, and Highly Suspect Billing Activity Recently, ACOs and other interested parties have raised concerns about an increase in billing to Medicare for selected intermittent urinary catheter supplies on Durable Medical Equipment, Prosthetics, Orthotics & Supplies (DMEPOS) claims in CY 2023, alleging that the increase in payments represents fraudulent activity (the alleged conduct)
We also propose edits to 425.204(f) replacing the phrase shared losses with shared losses and any prepaid shared savings in several paragraphs to clarify that CMS would be able to recoup outstanding prepaid shared savings from an ACO's repayment mechanism
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Department of Health and Human Services, Robert F
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