Tag: Office of Inspector General (OIG)

WASHINGTON – Over half of the falls among Medicare home health patients hospitalized for falls with major injury were not reported on patient assessments by home health agencies (HHAs) as required, according to a new Office of Inspector General report. Due to this high rate of non-reporting, Care Compare may not provide accurate information about the incidence of these falls, the OIG says. Reporting on OASIS assessments was worse among younger home health patients (compared to older patients)...

WASHINGTON – Medicare and its enrollees have saved $73.4 million since 2013, because of CMS’s price substitution policy for Part B covered drugs, according to an August issue brief from the Office of Inspector General. They could have realized an additional $889,000 in savings in 2021, if CMS expanded the price-substitution criteria, the OIG says. When Congress established average sales prices (ASPs) as the basis for reimbursement for Medicare Part B drugs, it also provided a mechanism...

WASHINGTON – Some people enrolled in Medicaid managed care may not be receiving all of their medically necessary health care services, according to a new study from the Office of Inspector General.  There are three key factors causing concern, the OIG says: the high number and rates of denied prior authorization requests; the limited oversight of prior authorization denials in most states; and the limited access to external medical reviews.  What the OIG found  Overall,...

LAFAYETTE, La. – Viemed Healthcare’s recent victory at the administrative law judge level of the Medicare appeals process is as much a win for the company as the HME industry, says CEO Casey Hoyt.  Earlier this month, an ALJ judge ruled in favor of Viemed, overturning all remaining disputed claims for non-invasive ventilation related to the findings of an Office of Inspector General report and ordering CMS to return 100% of the previously remitted funds to the company.  “DME...

WASHINGTON – The Office of Inspector General has published its annual “Top Unimplemented Recommendations: Solutions to Reduce Fraud, Waste and Abuse in HHS Programs” and DME makes more than one appearance.  This year, the OIG’s recommendations focus on the top 25 unimplemented recommendations that, in its view, would most positively affect HHS programs in terms of cost savings, program effectiveness and efficiency, and public health and safety if implemented.  Recommendations...

YARMOUTH, Maine – An Office of Inspector General report “understates” the actual cost of providing catheters, especially given the complexity of both Medicare’s documentation requirements and the needs of patients, say providers.  The report, released in September, found that Medicare payments for intermittent urinary catheters were 3.4 times supplier acquisition costs in fiscal year 2020 and recommended that CMS lower its reimbursement rates.  “I’d...

WASHINGTON – CMS has an opportunity to strengthen state oversight of reporting by Medicaid managed care plans on medical loss ratios (MLRs), according to a new report from the Office of Inspector General. States reported that most Medicaid managed care plans submitted MLR reports; however, the OIG found that 49% of the 495 MLR reports reviewed were incomplete. These incomplete MLR reports were missing at least one of seven numeric data elements that are essential to the MLR calculation....

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,”...