Inappropriate, questionable billing for test strips, says OIG

Tuesday, August 27, 2013

WASHINGTON – Medicare inappropriately allowed $6 million in claims for diabetes test strips in 2011, according to a report from the Office of Inspector General (OIG). The claims were for beneficiaries without a documented diagnosis code for diabetes, or for beneficiaries who were in hospitals or skilled nursing facilities. The OIG also found that $425 million in Medicare-allowed claims had characteristics of questionable billing, and that suppliers in 10 geographic areas nationwide were responsible for 77% of that questionable billing. CMS partially concurred with the OIG’s recommendations to enforce existing edits to prevent inappropriate claims, and to increase the monitoring of suppliers. It concurred with recommendations to provide mode education to suppliers and beneficiaries about appropriate billing practices, and to take appropriate action regarding inappropriate claims and suppliers with questionable billing. In all, Medicare allowed about $1.1 billion in claims to 51,695 suppliers for test strips to 4.6 million beneficiaries in 2011.