OIG to CMS: Rein in CPAP supplies

CMS did not concur with recommendation
 - 
Tuesday, June 25, 2013

WASHINGTON – The Office of Inspector General (OIG) recommends that CMS review and revise the replacement schedule for CPAP supplies in a report published today (June 26).

The OIG studied the replacement schedules of 50 fee-for-service state Medicaid programs and found that 39% had frequencies that were less than those under Medicare; 51% equaled those under Medicare; and only 10% exceeded those under Medicare.

“In 2012, CMS found that beneficiaries receiving CPAP treatment for obstructive sleep apnea may have received more supplies (e.g. masks, tubing) than medically necessary,” the OIG states. “Providing more supplies than necessary may lead to wasteful spending.”

The OIG also studied the replacement schedules of fee-for-service Federal Employees Health Benefits plans and found they didn’t have set frequencies. Instead, frequencies were based on medical necessity.

Finally, the OIG collected recommendations from five sleep disorder clinicians and four manufacturers. The clinicians emphasized the importance of proper fit, but the OIG’s research showed that once proper fit is established, the replacement of masks is less frequent than Medicare allows. Manufacturers recommended specific replacement schedules for only a few types of supplies on an as-needed basis and potentially less frequent than Medicare allows.

CMS did not concur with the OIG’s recommendation that it review and revise the replacement schedule for CPAP supplies. The agency stated that failure to consider noncompliance or the potential impact of supplier fraud or abuse would bias the estimate of a clinically appropriate refill rate.