OIG gears up for DME investigations

Tuesday, January 31, 2006

WASHINGTON - When it comes to investigating how CMS spends money for durable medical equipment, the Office of Inspector General appears intent on leaving no stone unturned. The agency, which investigates federal health and welfare program management, unveiled its 2006 Work Plan recently.
Here are some DME issues it plans to look into:
Under certain circumstances, Medicare covers therapeutic footwear for beneficiaries who have diabetes and at least one of several related conditions. Medicare payments for therapeutic footwear totaled over $130 million in 2003. A previous OIG report indicated that a significant percentage of payments made for therapeutic footwear did not have adequate documentation.
The OIG will determine the appropriateness of Medicare payments for certain items of durable medical equipment, such as power wheelchairs, wound care equipment and supplies and glucose test strips. It will assess whether suppliers' documentation supports the claim, whether the item was medically necessary, and/or whether the beneficiary actually received the item.
The OIG will compare Medicare payment rates for certain medical equipment and supplies with the rates of other federal and state health programs, as well as with wholesale and retail prices. The review will cover such items as wheelchairs, parenteral nutrition, wound care equipment and supplies and oxygen equipment and supplies.
The OIG will assess the appropriateness of Medicare Part B payments made to a supplier for home blood glucose testing supplies, specifically test strips and lancets. Medicare covers the supplies based on the medical needs of the diabetic patients. The utilization guidelines issued by Medicare allow up to 100 test strips and 100 lancets every three months for non-insulin treated patients, and up to 100 test strips and 100 lancets every month for insulin treated patients. However, Medicare may cover supplies in quantities greater than the utilization guidelines if certain criteria are met.