OIG Zeroes in on HME

Every year HHS' Office of Inspector General posts its annual work plan, a summary of reports it is or will be working on over the next fiscal year. For FY 2011, similar to prior years, a series of reports that focus on DMEPOS are included in the OIG's work plan.

Some OIG reports are required by Congress; others are done because the OIG has identified specific vulnerabilities in the Medicare program. Once reports are issued, they contain the OIG's specific recommendations to Congress and to the Centers for Medicare and Medicaid Services on how to address the problems. These reports are an important mechanism to understanding the government's specific areas of scrutiny.

Several reports related to Medicare's competitive bidding program are included on the OIG's DME work plan for the coming year. Following is a summary:

• Competitive Bidding Process for Medical Equipment and Supplies

  The OIG will review the process CMS used to conduct competitive bidding and subsequent pricing determinations for certain DMEPOS items and services in selected competitive bidding areas under Rounds 1 and 2 of the program.

  The 2008 Medicare Improvements for Patients and Providers Act (MIPPA) requires the OIG to conduct post-award audits to assess the process CMS used for bidding and to look at its pricing determinations. The report is expected to be issued in FY 2011.

• Competitive Bidding Program: Supplier Influence on Physician Prescribing

  The OIG will review DME claims to determine the extent to which suppliers participating in the competitive bidding program are soliciting physicians to prescribe certain brands or modes of delivery of covered items that are more profitable. The competitive bidding law requires the OIG to conduct this review.

  The OIG will also examine billing patterns to identify changes resulting from competitive bidding. This new report will be issued in FY 2012.

• Medicare Market Shares of Mail-Order Diabetic Test Strips

  The OIG will determine the brands and models of diabetic test strips reimbursed by Medicare. Under the competitive bid law, Congress required the OIG to complete a study of diabetic test strip products and submit it to the HHS Secretary before Jan. 1, 2011.