CPAP supplies: OIG adds another layer of scrutiny

WASHINGTON - Providers who get request letters from the Office of Inspector General for documentation for CPAP replacement supplies need to take them seriously, because there could be a lot of money at stake, say industry stakeholders.

Providers who receive such a request from the OIG are asked to either audit 100% of their claims for supplies going back six years, or pull a statistically valid random sample and extrapolate the results.

“Providers have to pay attention because the potential downstream impact could be very significant,” said Wayne van Halem, president of the van Halem Group. “A number of suppliers are going to get requests for documentation on a single claim and because it's a single claim may not think there's much to it, but now we know what the potential repercussions are if that claim gets denied.”

The OIG recently updated its Work Plan to include reviews for CPAP replacement supplies. This follows a decision by the DME MACs about a year ago to ask certain providers to self-audit their claims for supplies.

van Halem worked with a number of providers last year who received such requests from the DME MACs, resulting in overpayments ranging from $30,000 to more than $1 million. Even when there is no overpayment, it can be an expensive process if providers hire outside help from consultants and attorneys, he said.

“Even when they don't have to refund money, they have to spend money to resolve the issue,” he said.

Provider Josh Eckstein says he's made it a practice to self-audit his claims for supplies.

“I have my own internal auditing processes to make sure I have everything I need—I won't dispense anything until I have a copy of their sleep study and everything I would need to possibly pass an audit,” said Eckstein, vice president of compliance and patient care for Reliant Medical in Buffalo, N.Y.

Still, providers say these requests by the DME MACs and now the OIG, particularly the six-year look-back period, aren't fair.

“With that many claims, there will be patients that have passed away,” said Jason Jones, president of Troy, Ala.-based Jones Medical Supply. “You've got to look in other sections of your storage facilities. There's no payment for that.”