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Florida Generally Ensured That Providers Complied With Selected State Durable Medical Equipment Enrollment Requirements

The Florida Agency for Health Care Administration (State agency) generally ensured that durable medical equipment (DME) providers complied with selected Florida DME enrollment requirements. Of the 71 DME providers that we visited in Miami-Dade County and that received a total of about $15 million from Medicaid during the 13 months prior to our site visits, 61 providers complied with the selected enrollment requirements. However, 10 providers did not comply: 6 did not have the required signage to identify them as DME providers, 2 either did not meet the business-hour requirements or were not open during posted business hours, and 2 did not notify the State agency that their business addresses had changed.

These 10 providers did not comply with the enrollment requirements because the State agency did not maintain proper oversight through periodic monitoring. As a result of the State agency's lack of periodic monitoring of DME providers, the Medicaid DME program in general and the $1.9 million that the State agency claimed for these 10 providers were vulnerable to fraud, waste, and abuse.

We recommended that the State agency (1) terminate, sanction, or recoup Medicaid funds from the providers not in compliance with the State agency's DME enrollment requirements and (2) strengthen enrollment procedures to include recurring site visits to ensure that DME providers comply with the State agency's enrollment requirements.

Filed under: Center for Medicare and Medicaid Services