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Tag: OIG report


OIG questions Medicaid spending by managed care plans 

September 27, 2022HME News Staff

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....

Medicaid Managed Care, medical loss ratio, OIG report

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Casey Hoyt

Specialty Providers

Viemed pushes back on OIG’s findings

May 25, 2021HME News Staff

LAFAYETTE, La. – Viemed Healthcare says a recent report from the Office of Inspector General shows how disconnected investigators are from CMS’s clinical protocols for non-invasive ventilators and shines a light on the lack of understanding of the critical role HME providers play in providing this life-saving care to patients.  The OIG in May published a report saying most of the Medicare claims submitted for the monthly rental of NIV by Viemed, under its original name Sleep...

Non-invasive ventilators, OIG report, Viemed Healthcare

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OIG calls on CMS to improve consistency in reviews

August 28, 2020HME News Staff

WASHINGTON - Medicare contractors were inconsistent in how they reviewed overpayments during the appeals process, says the Office of Inspector General in a new report. Although MACs and QICs generally reviewed appealed extrapolated overpayments in a manner that conforms with existing requirements, CMS did not always provide sufficient guidance and oversight to ensure that these reviews were performed in a consistent manner, the report states. The most significant inconsistency involved a type of...

OIG report

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In brief: Proposed rule includes home infusion changes, OIG report reviews 'place-of-service' claims

July 3, 2018HME News Staff

WASHINGTON - Temporary transitional payments for home infusion therapy are moving forward, according to an upcoming proposed rule.The rule, which will be published in the July 12 Federal Register, contains information on the implementation of the payments, which will fix a payment gap created by the 21st Century Cures Act. The Cures Act requires Medicare to pay for services associated with providing Part B home infusion drugs, but not until 2021.The temporary payment, which was passed as part of...

Home Infusion, OIG report, place-of-service claims, temporary payment

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In brief: OIG tells CMS to collect more overpayments, VGM announces Woman of the Year finalists

October 6, 2017HME News Staff

WASHINGTON - The MACs collected only 20% of Medicare overpayments referred by ZPICs and PSCs in 2014, says a new report from the Office of Inspector General.The ZPICs and PSCs referred $559 million in overpayments in 2014, but the MACs sought $482 million and collected only $96 million, according to the OIG.The ZPICs and PSCs send the highest number of referrals for Part B (60%) and DME (26%). They sent the highest dollar amount of referrals, however, for home health and hospice (43%), the OIG found.In...

HME Audit Key, HME Woman of The Year, OIG report, Overpayments

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Specialty Providers

OIG updates Medicare market shares for diabetes test strips

February 7, 2017HME News Staff

WASHINGTON - Suppliers in Medicare's national mail-order program provided 18 types of diabetes test strips to beneficiaries from July through September 2016, according to a new report from the Office of Inspector General.The top strip type accounted for 43% of the mail-order market, and the top 10 strip types accounted for 98% of the market, the OIG found.The OIG conducted its report by sampling 1,210 claims from a population of 456,784 claims for mail-order test strips.Suppliers must comply...

Diabetes Test Strips, Market share, OIG report

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Spring's gotcha!

April 16, 2014Theresa Flaherty, Managing Editor

On Saturday, I cracked open a window, cleaned out my car and stowed my winter boots in the closet. This morning, I donned mittens while I chipped snow and ice off of my car (in Maine, we keep the ice scrapers at hand year round). Ahh spring. Last week, the industry got whacked with its own wet blanket: Two reports issued by the OIG and the GAO on the competitive bidding program. The first found that CMS generally complied with its own bidding rules and said that CMS should continue to follow its...

aahomecare, GAO report, OIG report, VGM, Washington Legislative Conference

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OIG weighs in on CMS oversight of bid program

April 8, 2014HME News Staff

WASHINGTON - As part of the Round 1 of competitive bidding, CMS generally selected DMEPOS suppliers and correctly computed the sampled single payment amounts in accordance with its established procedures and applicable federal requirements, according to a report published today by the Office of Inspector General (OIG).Specifically, the OIG determined that for 255 of the 266 contract suppliers associated with the sampled single payment amounts reviewed, CMS consistently followed its procedures and...

Competitive Bidding, OIG report

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What's good for the goose is good for the gander

January 25, 2013Letter to the Editor

I read the article titled “New OIG report: Is it good or bad?” (January 2013). While I would agree that current CMS policy is too ambiguous to allow for consistent determination of claim reimbursement, I do not agree that CMS's proposal of requiring providers to pay for appeals is appropriate unless the following is allowed: If CMS requires providers to pay a fee to appeal a denied or recouped claim, we can accept that only if, when the provider wins the appeal at any level, the fee is...

CMS, Home Medical Equipment, OIG report

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