OIG Aims at HME — Again

WASHINGTON — HHS' Office of Inspector General has released its 2011 work plan and, as in 2010, various investigations and audits of Medicare payments to HME providers are on the hit list.

The OIG said it will look at:

• Payments for power mobility devices, hospital beds, oxygen concentrators and enteral/parenteral nutrition. According to the OIG, prior reviews "have identified issues such as Medicare payments for DME that was not ordered by physicians, not delivered to the beneficiaries, or not needed by beneficiaries."

• Replacement supplies. The OIG notes preliminary work showed "suppliers automatically shipped continuous positive airway pressure system and respiratory-assist device supplies when no physician order for refills was in effect."

• Documentation for standard and complex rehab wheelchairs "to determine whether the claims were medically necessary."

• Claims with modifiers. Reviews by the DME MACs have shown "that suppliers had little or no documentation to support their claims," the OIG said, "suggesting that many of the claims submitted may have been invalid and should not have been paid by Medicare."

• The fee schedule for parenteral nutrition. The OIG previously found that Medicare allowances for major parenteral nutrition codes "averaged 45 percent higher than Medicaid prices, 78 percent higher than prices available to Medicare risk-contract health maintenance organizations and 11 times higher than some manufacturers' contract prices."

• Payments for home blood glucose test strips and lancet supplies.

• Qualifications of orthotists and prosthetists, and payments for lower-limb prostheses.

The new targets follow a slew of reports related to HME that have poured out of the OIG in recent weeks — evidence that the agency honored its 2010 work plan, which also focused on the sector.

In September, the OIG reported that CMS shelled out an estimated $8.2 million worth of Part B payments for equipment and services for dead Medicare beneficiaries. In a wry note, the report stated: "Because medically necessary services cannot be provided after a beneficiary dies, payments for claims with dates of service after a beneficiary's death are overpayments."