Tag: Office of inspector general
OIG investigates payments for hospice beneficiaries
November 22, 2021HME News Staff
WASHINGTON – Medicare improperly paid suppliers an estimated $117 million over four years for DMEPOS provided to hospice beneficiaries, according to a new report from the Office of Inspector General.
Specifically, for 58% of the sampled DMEPOS items billed without the GW modifier (67 of 115 items) and 63% of those billed with the GW modifier (54 of 85 items), the items were provided to palliate or manage a beneficiary’s terminal illness and related conditions. The GW modifier...
OIG sticks to script on Medicaid pricing
April 13, 2016HME News Staff
WASHINGTON - The Office of Inspector General has reiterated its recommendation that CMS match Medicaid reimbursement rates for HME to Medicare rates.The recommendation, published this week in the OIG's April 2016 “Compendium of Unimplemented Recommendations,” suggests that CMS seek legislative authority to limit Medicaid reimbursement rates for DMEPOS to Medicare rates and further reduce those rates through competitive bidding or manufacturer rebates.Lowered reimbursement rates could...
OIG report finds jump in redeterminations
May 29, 2014HME News Staff
WASHINGTON - Medicare contractors processed 2.9 million redeterminations in 2012, an increase of 33% since 2008, according to the Office of Inspector General (OIG) semi-annual report to Congress. As a result, the OIG calls on CMS to use the Medicare Appeals Process to monitor contractor performance, share information and keep an eye on the quality of redeterminations data. Also in the report: the OIG says it expects more than $3.1 billion in recoveries—$295 million from audits and $2.83...
OIG rips on HME documentation
January 28, 2010HME News Staff
WASHINGTON - About 50% of the time, the KX modifier does not ensure that HME providers have the required supporting documentation on file, according to a new report from the Office of Inspector General (OIG).
The OIG examined 100 claims with the KX modifier from 2006 totaling $8,809. It found that providers didn't have the required documentation on file for 54 claims totaling $4,574.
"Based on our sample, we estimated that Palmetto GBA (the DMERC for Jurisdiction C at the time) paid approximately...