OIG peels back the covers on sleep

Sunday, October 19, 2008

WASHINGTON -The Office of Inspector General (OIG) has big plans for CPAP providers. It will increase audits next year.

The scrutiny is part of the OIG's Work Plan for 2009, which states: "Previous OIG work revealed cases in which Medicare paid for CPAP devices that were not used by or delivered to beneficiaries. We will determine whether Medicare payments for CPAP devices were supported, billed, and paid in accordance with Medicare requirements."

Medicare spent $571 million for CPAPs in 2007, up from $291 million in 2004, according to Medicare data published by USA Today in August. Any increase in utilization throws up a red flag for the OIG, says Clay Stribling, a healthcare attorney with Brown & Fortunato in Amarillo, Texas.

But utilization is not spiking because of fraud, he said.

"It's spiking because of increased awareness and the diagnosis of a legitimate and established condition," Stribling said.

Additionally, the OIG plans to review sleep study payments, which increased from $62 million in 2001 to $215 million in 2005, according to the work plan.

The post-payment reviews will probably go back two to four years, said Stribling. The best thing providers can do: Conduct their own audits now, he said.

"Pull 30 charts today, look at them and see the status of documentation," Stribling said. "The large companies that are going to be the first targets might want to get a fresh set of eyes on it by hiring an outside firm."

Provider Helen Kent understands that the OIG is trying to make sure taxpayer money is well spent, but she says its approach is "pennywise and pound foolish." Using CPAPs to treat sleep disorders results in long-term savings to the healthcare system, she said.

"Medicare doesn't understand that if they don't fix sleep disordered breathing, they are going to have to pay for other, very expensive chronic conditions like diabetes and high blood pressure," Kent said. "We've done a good job of educating the public--now the Feds want to come and close the door."