Tag: OIG

WASHINGTON – High-risk providers represent a small portion of all providers who billed for a telehealth service, but strong, targeted oversight of these services is still important, according to a new report from the Office of Inspector General.  The OIG identified 1,714 providers out of about 742,000 whose billing for telehealth services during the first year of the pandemic posed a high risk to Medicare, representing a total of $127.7 million in Medicare fee-for-service payments for...

WASHINGTON – Medicare payments for intermittent urinary catheters were 3.4 times supplier acquisition costs in fiscal year 2020, according to a new analysis by the Office of Inspector General.  In total, Medicare allowed $407 million in payments for these items, while suppliers paid approximately $121 million to acquire them.   Each of the three billing categories for intermittent urinary catheters (straight tip, curved tip, and sterile kit) showed large differences between...

WASHINGTON – More than two in five Medicare beneficiaries, or 28 million, used telehealth during the first year of the COVID-19 pandemic, according to a new report from the Office of Inspector General.  In total, beneficiaries used 88 times more telehealth services during the first year of the pandemic than they used in the prior year, the OIG found.  “Telehealth was critical for providing services to Medicare beneficiaries during the first year of the pandemic,”...

CareCentrix has notified providers servicing Florida Blue beneficiaries that they will be adding ambulatory aids, such as canes and walkers, to the list of non-life-sustaining products subject to suspension for patient balances that are 180 days past due, starting Feb. 1, AAHomecare reports. CareCentrix first implemented this policy for CPAP and PAP supplies in June…The Office of Inspector General will conduct a report on supplier acquisition costs for urinary...

WASHINGTON - The Department of Health and Human Services Office of Inspector General, along with state and federal law enforcement partners, has conducted a national “telefraud” takedown involving more than $6 billion in alleged losses. The fraudulent activity has resulted in charges for 345 defendants, including telemedicine companies, DME companies, genetic testing labs, pharmacies and more than 100 medical practitioners, in 51 judicial districts. Health care billing privileges have...

WASHINGTON - Medicare pays more for non-invasive ventilators than certain other payers, according to a new report from the Office of Inspector General.The OIG estimates that Medicare and beneficiaries could have saved $86.6 million if Medicare-allowed charges were comparable with payment rates of select non-Medicare payers for HCPCS code E0466.Medicare paid $424.4 million for non-invasive vents in 2018, a 52% increase compared to 2016, the OIG found.The agency believes Medicare pays more for non-invasive...

WASHINGTON - The average sales price for 11 drug codes in the third quarter of 2019 met CMS's price substitution criteria by exceeding the average manufacturer price by 5% for two consecutive quarters or three of the previous four quarters, according to a new report from the Office of Inspector General. When the ASP exceeds the AMP by 5%, the Department of Health and Human Services substitutes the ASP-based amount with a lower calculated rate, either 103% of the AMP or the widely available market...

WASHINGTON - The Veterans Health Administration is at risk of potentially spending $261.3 million over the next five years on sleep apnea devices and supplies that veterans will not use, according to the Office of Inspector General.Nearly half of the almost 114,000 veterans who were not consistently using their devices did not receive the necessary follow-up care, the OIG found.“Sleep medicine clinicians at VA medical facilities told the audit team they were unable to use available usage data...

WASHINGTON - Not all suppliers comply with Medicare requirements when billing for inhalation drugs, according to the Office of Inspector General. For 81 of the 120 sampled claim lines, suppliers complied with requirements; for the remaining 39 claim lines, 22 suppliers did not comply with requirements. The OIG says the documentation from these suppliers contained incomplete, invalid or missing detailed written orders; incomplete proof of delivery; incomplete refill requests; and no medical records....

WASHINGTON - Medicare allowable amounts for certain orthotic devices are not comparable with payments made by select non-Medicare payers, according to the Office of Inspector General.For calendar years 2012-15, the OIG estimated that Medicare and beneficiaries paid $341.7 million more than select non-Medicare payers on 142 HCPCS codes and $4.2 million less than select non-Medicare payers on 19 codes. Of the net $337.5 million difference, the agency estimated that Medicare paid $270 million and beneficiaries...