Tag: Office of Inspector General (OIG)
OIG: SMP projects have room for improvement
June 18, 2025HME News Staff
WASHINGTON – Senior Medicare Patrol projects in 2024 made $35,115,211 in expected Medicare recoveries and $99,037 in cost avoidance on behalf of Medicare, Medicaid, beneficiaries and others, according to a new report from the Office of Inspector General (OIG). In 2024, SMP projects, which are funded by grants for the Administration for Community Living, had 5,643 active team members; conducted 22,752 group outreach and education events; and had 283,724 individual interactions with, or on behalf...
OIG: MACs miss mark on cost reports
March 20, 2025HME News Staff
WASHINGTON – Medicare Administrative Contractors did not consistently meet Medicare cost report oversight requirements, according to a new report from the Office of Inspector General.
For federal fiscal years 2019–2021, each of the 12 MAC jurisdictions failed to comply with the contract requirements for audit and reimbursement desk review and audit quality (AR-4) for at least one of the three years.
CMS identified 287 total audit issues among all MAC jurisdictions during...
Spending on diabetes drugs skyrockets, gov’t says
February 25, 2025HME News Staff
WASHINGTON – Medicare Part D spending for 10 selected diabetes drugs totaled more than $35.8 billion in 2023, a 364% increase from 2019, according to a new data brief from the Department of Health and Human Services Office of Inspector General.
Meanwhile, the number of Medicare Part D enrollees increased from 44.9 million to 50.5 million, a 12% increase.
“Certain diabetes drugs initially approved by the Food and Drug Administration to help control blood sugar levels...
OIG investigates catheter billing
February 24, 2025HME News Staff
WASHINGTON – The Office of Inspector General estimates that Medicare improperly paid $35.1 million for catheters and kits from July 2021 through July 2022.
The agency paid a total of $303.3 million for catheters and kits during that time period.
The OIG found that:
Payments for 88 of 105 sample items met requirements. (It did not review 2 of 105 sample items and treated them as non-errors because after it had selected its sample, we determined that Medicare contractors...
In brief: Medicare spending, OIG savings, telehealth flexibility, cath reviews
December 11, 2024HME News Staff
WASHINGTON – Medicare spent 27% more, on average, for people who were covered by traditional Medicare after disenrolling from Medicare Advantage than for people who were continuously covered by traditional Medicare, after adjusting for differences in health status and other characteristics, according to a new analysis by the Kaiser Family Foundation.
This is a difference of $2,585 in Medicare spending per person, on average, between the two groups in 2022.
Other highlights...
HHS-OIG highlight $7B in savings in new report
December 9, 2024HME News Staff
WASHINGTON – The Fall 2024 Semiannual Report to Congress (SAR) highlights more than $7 billion in expected recoveries and receivables resulting from HHS-OIG investigations and audits conducted during fiscal year 2024. HHS-OIG reported 1,548 criminal and civil enforcement actions in FY 2024 against individuals and entities suspected of engaging in crimes targeting HHS programs and the people they serve, including settlements resulting from using OIG's civil monetary penalty authorities...
OIG adds reviews for wheelchair repairs, oxygen
October 31, 2024HME News Staff
WASHINGTON – The Office of Inspector General added wheelchair repairs and oxygen and oxygen equipment to its work plan in October. For wheelchair repairs, the OIG will examine suppliers who provide these services and will consider the duration of repairs, their implementation of selected quality standards, and their identification of deficiencies related to wheelchair repairs. It will review documentation from wheelchair suppliers and accreditation organizations and conduct interviews with...
OIG to Medicare: Adjust allowables for orthotic devices
October 21, 2024HME News Staff
WASHINGTON – The Office of Inspector General has included on its “Top Unimplemented Recommendations” list a recommendation that Medicare review Medicare allowable amounts for 161 orthotic device HCPCS codes that it says the agency and its beneficiaries have paid an estimated $337.5 million more for than select non-Medicare payers. The OIG also recommends that Medicare adjust the allowable amounts, as appropriate, using regulations promulgated under existing legislative authority...
OIG: More oversight needed of remote patient monitoring
September 25, 2024HME News Staff
WASHINGTON – CMS needs to provide more oversight of remote patient monitoring to ensure it is being used and billed properly, says a new report from the Office of Inspector General.
From 2019 to 2022, use of remote patient monitoring increased dramatically, from about 55,000 enrollees to 570,000. In 2022, payments for these services by traditional Medicare and Medicare Advantage were more than $300 million, compared to just $15 million in 2019.
However, the OIG found 43% of...
In brief: Walgreens creates new pharmacy biz, CQRC contributes to hearing, OIG contacts CGM providers
May 1, 2024HME News Staff
DEERFIELD, Ill. – AllianceRx Walgreens Pharmacy will become Walgreens Specialty Pharmacy effective Aug.1, 2024, in a move that Walgreens says will expand care for patients with complex, chronic conditions.
Walgreens will now have nearly 300 community-based specialty pharmacies nationwide, with more than 1,500 specialty-trained pharmacists, 5,000 patient advocacy support team members and dedicated Specialty360 teams that support all specialty conditions and therapies.
“With...