OIG concerned about surrogate UPIN habits

Thursday, October 31, 2002

WASHINGTON — A September report from the OIG estimates that 61% of Medicare claims for DME products that sport surrogate UPINs should have used permanent UPINs, and it suggests that CMS take a harder look at claims with surrogate numbers.

CMS Administrator Tom Scully has concurred with concerns raised by the OIG report, and has said that CMS will step up monitoring of UPINs, as well as educate suppliers and providers of their responsibility to make sure the proper UPINs appear on reimbursement claims.

OIG and CMS are concerned about the potential for fraudulent billings because surrogate UPINs on DME claims allow them to be processed automatically whether a physician actually ordered the equipment or not.

Although it doesn't quantify how much fraud might be occurring, the OIG report did note that nearly half of the claims it reviewed with surrogate UPINs were missing written orders, CMNs or supporting documentation. Medicare paid an estimated $61 million for those services in 1999. HME

Much like the fallout from an OIG report on the use of invalid UPINs, the onus of making sure the right numbers are used falls to the DME suppliers and providers who submit the claims.

"Medicare has a lot bigger fish to fry right now, but Tom Scully does seem to be taking this pretty seriously, so medical equipment providers need to remain aware and alert if they don't want to get caught on this later on," said Bruce Brothis, president and CEO of Centralized Billing & Intake in Parker, Colo. "It's not really an onerous burden. There are plenty of resources, including the Internet and a CD-ROM from the government, where you can find a physician's actual UPIN."

Brothis also cautions suppliers and providers against using surrogate number OTH000 as a "crutch" for missing UPINs rather than looking up a physician's actual UPIN.

Terri Maggio, executive director of the Jersey Association of Medical Equipment Suppliers, doesn't expect the new scrutiny to pose much of a challenge or burden to medical equipment suppliers unless they get a great many orders written by residents.

"Where this issue can become confusing at times is when the residents at hospitals write up orders but they use the UPIN of their chief of staff or something like that," Maggio said. "The UPIN is valid, but it doesn't match with the name, and that's a problem." HME