OIG report faults Medicare contractor

Wednesday, September 8, 2010

WASHINGTON - Medicare overpaid nearly $40 million for diabetes test strips and lancets in 2007 in Jurisdiction A, according to a new report from the Office of Inspector General (OIG).

In "Review of Medicare Claims for Home Blood-Glucose Test Strips and Lancets," the OIG states that NHIC, the DME MAC for Jurisdiction A, failed to require proper authorization, leading to the overpayments.

Only 30 of 100 sampled claims were in compliance, according to the report. The other 70 were deficient in the following areas:

* Documentation did not support the quantity of excess supplies; the specific reason for additional supplies; the frequency of testing; and/or the treating physician's evaluation of the patient's glucose control (55 claims).

* No documentation supporting that refill requirements had been met.

* Physician orders were missing or incomplete (24 claims).

* Proof-of-delivery records were missing (seven claims).

The OIG audit looked only at "high utilization" claims--those that exceeded 100 test strips and 100 lancets each month for insulin-dependent beneficiaries and every three months for non-insulin dependent beneficiaries.

For these claims, the physician must meet additional requirements for the HME supplier to be paid: The physician must have seen the patient and evaluated the patient's blood glucose control within six months, and the physician must have documented the reason that additional supplies were necessary.