Legal Analysis: Review work plan updates

Q. As a Medicare supplier, what are the key risk areas that regulators are currently evaluating?

A. The best place to start when being proactive is to review the latest work plan updates issued by the Office of the Inspector General (OIG) within the U.S. Department of Health and Human Services (HHS). The mission of the OIG is to protect the integrity of federal healthcare programs, as well as their beneficiaries, by detecting and preventing fraud, waste and abuse. These efforts are demonstrated in the OIG Work Plan that identifies different projects that are in progress or planned to be addressed in the near future, as part of OIG's overall mission. CMS receives this report and responds with actions to be taken based on the findings of the report.

For example, here are two projects announced in the final months of 2019 aimed at the durable medical equipment sector. First, OIG announced it plans to scrutinize supplier compliance related to the replacement of supplies for CPAP devices (e.g. mask, tubing, filters, etc.). According to the OIG, prior reviews have found that most Medicare claims submitted for replacement did not comply with Medicare requirements. Expect that OIG will aim its efforts at frequently replaced CPAP supplies to determine whether all documentation requirements are met and additionally, whether refills are automatically shipped on a predetermined basis.

Likewise, OIG also announced it is reviewing claims related to replacement parts for power mobility devices (PMDs). Here, the OIG will likely be evaluating claim supporting documentation to ensure that the PMD being repaired continued to be medically necessary and that the repairs were reasonable and
necessary.

Assessing and monitoring items included in the work plan should be a key component of every supplier's compliance plan. This not only allows suppliers to make timely and necessary changes but ensure continued compliance in key risk areas.

Matthew Fischer is partner and health law attorney at Zumpano Patricios. Reach him at 305.444.5565 or mfischer@zplaw.com.