OIG investigates catheter billing 

WASHINGTON – The Office of Inspector General estimates that Medicare improperly paid $35.1 million for catheters and kits from July 2021 through July 2022. 

The agency paid a total of $303.3 million for catheters and kits during that time period. 

The OIG found that: 

• Payments for 88 of 105 sample items met requirements. (It did not review 2 of 105 sample items and treated them as non-errors because after it had selected its sample, we determined that Medicare contractors had denied the claims.) 
• Payments for the remaining 15 sample items did not meet requirements. Specifically, medical records did not support eligibility for curved-tip catheters or sterile catheter kits, or suppliers did not meet Medicare requirements for catheter refills, proof of delivery, or a standard written order. 

The OIG also found that suppliers billed 125,426 claims for curved-tip catheters to female Medicare beneficiaries in 2023 compared to 2,753 from July 2021 through July 2022. 

“This large increase in claims billed may be an indication of improper claims,” the OIG stated. “We shared our analysis, identifying suppliers with questionable billing patterns, with CMS so that it could take action as needed. In comments on our draft report, CMS informed us that it had already taken corrective action on 15 suppliers.” 

The agency recommends that CMS: 

• Instruct Medicare contractors to recover $11,399 in overpayments made to suppliers for the 15 sample items that did not meet Medicare requirements; 
• Perform additional medical reviews of claims for catheters and kits, which could have saved Medicare an estimated $35.1 million for our audit period; and 
• Provide additional education to suppliers on documenting eligibility for curved-tip catheters and kits and on documenting refills of catheters and kits. The full recommendations are in the report. 

CMS concurred with all the OIG’s recommendations except one related to the 60-day-rule requirements for suppliers. The OIG removed that recommendation. 

Read the OIG’s full report here.