OIG report highlights DME

Sunday, December 7, 2008

WASHINGTON - The Office of Inspector General (OIG) detailed healthcare savings and expected recoveries of more than $20.4 billion for fiscal year 2008 in a semiannual report to Congress last week.

The report highlights an investigation into CMS's error rate for DME as one of the OIG's "significant accomplishments." After reviewing additional medical records from physicians, documentation from providers and other information from beneficiaries, the OIG found that CMS's error rate should have been 28.9% not 7.5%. The OIG recommended that CMS begin requiring its contractors to review all available medical records and documentation to determine compliance and medical necessity.

For 2008, the OIG's savings and expected recoveries include $16.72 billion in implemented recommendations, $1.33 billion in audit receivables and $2.35 billion in investigative receivables.

Additionally, the OIG excluded 3,129 individuals and organizations from participating in federal healthcare programs for convictions for healthcare crimes, patient abuse and neglect or license revocation. It also reported 775 criminal actions and 342 civil actions.

To read the OIG's report: