OIG maps out busy 2012

Tuesday, October 4, 2011

WASHINGTON - The Office of Inspector General's 2012 Work Plan puts DME supplies on the hot seat, particularly those supplies that are automatically shipped to Medicare beneficiaries.

"A beneficiary or a beneficiary's caregiver must specifically request refills of repetitive services and/or supplies before a supplier dispenses them," states the report.

Suppliers of diabetes testing supplies, in particular, can expect increased scrutiny, as the OIG plans to investigate effectiveness of edits to prevent payments to multiple suppliers of the supplies; and questionable billing for the supplies.

Other DME-related items in the work plan:

Medicare enrollment and monitoring for DMEPOS suppliers

Medicare contractors must conduct prescreening, verification, validation and final processing of Medicare provider enrollment applications.

Medicare payments for various categories of DME

The OIG will identify suppliers in certain geographic areas with high-volume claims and reimbursement for power mobility, hospital beds and accessories, oxygen concentrators, and enteral/parenteral nutrition.

The OIG also plans to examine competitive bidding on several fronts, including:

Support surface pricing

The OIG will compare supplier acquisition costs to Medicare payments rates, and review whether competitive bidding rates have affected patient access to appropriate suppliers and services.

Supplier solicitation of physician prescribing

The OIG will interview physicians to determine whether contract suppliers are asking physicians to prescribe certain brands or modes of delivery for covered items that are more profitable for suppliers. The OIG will also examine billing patters to identify changes resulting from competitive bidding.

To read the entire 2012 work plan: http://go.usa.gov/93X .