OIG criticizes supplier documentation for inhalation drugs

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Tuesday, November 5, 2019

WASHINGTON – Not all suppliers comply with Medicare requirements when billing for inhalation drugs, according to the Office of Inspector General. For 81 of the 120 sampled claim lines, suppliers complied with requirements; for the remaining 39 claim lines, 22 suppliers did not comply with requirements. The OIG says the documentation from these suppliers contained incomplete, invalid or missing detailed written orders; incomplete proof of delivery; incomplete refill requests; and no medical records. The agency estimates that, on the basis of this sample, Medicare wrongly paid $92.5 million to suppliers. The OIG recommends that CMS instruct the Medicare contractors to recover nearly $37,000 in overpayments for the 39 unallowable claim lines and notify the 22 suppliers associated with these claim lines of the potential overpayments so that they can investigate and return any identified overpayments. It also suggested CMS work with Medicare contractors to expand their review of inhalation drug claims and provide additional training.