Tag: OIG
AAHomecare roundup: CareCentrix, OIG
January 11, 2021HME News Staff
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...
Gov't charges 345, revokes billing privileges for 256
October 13, 2020HME News Staff
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...
OIG: Medicare pays too much for non-invasive vents
September 22, 2020HME News Staff
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...
OIG: ASP continues to exceed AMP for certain drugs
March 10, 2020HME News Staff
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...
Large number of vets not receiving follow-up care for their sleep apnea, OIG says
January 29, 2020HME News Staff
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...
OIG criticizes supplier documentation for inhalation drugs
November 5, 2019HME News Staff
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....
OIG to CMS: Adjust payments for orthotic devices
November 5, 2019HME News Staff
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...
OIG to CMS: Collect Medicaid overpayments
December 12, 2018HME News Staff
WASHINGTON - CMS did not collect $1.6 billion in Medicaid overpayments in 77 current period audits and $188.6 million in seven prior period audits, according to a new report from the Office of Inspector General.The OIG reviewed CMS's efforts to collect overpayments identified in 313 audits in fiscal years 2010-15 (the current period) that recommended recovering overpayments totaling $2.7 billion and 10 audits in 2004-09 (the prior period) that recommended recovering overpayments totaling $225.6 million....
OIG to CMS: Take stronger look at 'place-of-service' claims
July 2, 2018HME News Staff
WASHINGTON - CMS's edits didn't detect $18.4 million in payments in 2015 for inappropriate claims for DME provided during non-covered stays in skilled-nursing facilities, according to a report from the Office of Inspector General.This represents 6% of all payments for DME during non-covered stays in SNFs, the OIG says.CMS uses two edits that are designed to identify and reject such claims, but neither edit rejected the claims because SNFs and DME suppliers did not submit full and accurate information...
VA slow to repair wheelchairs, OIG finds
March 20, 2018HME News Staff
WASHINGTON - The Office of Inspector General has found that veterans waited an average of 69 days for power wheelchair and scooter repairs, more than a month beyond a 30-day timeliness benchmark set by the agency, according to a new report. “These delays occurred because staff and prosthetic service managers at the respective VA medical facilities did not always effectively manage and monitor repair requests,” the OIG stated in a report. “VA medical facility staff, including prosthetic...