Tag: Office of Inspector General (OIG)
In brief: Walgreens creates new pharmacy biz, CQRC contributes to hearing, OIG contacts CGM providers
May 1, 2024HME News Staff
DEERFIELD, Ill. – AllianceRx Walgreens Pharmacy will become Walgreens Specialty Pharmacy effective Aug.1, 2024, in a move that Walgreens says will expand care for patients with complex, chronic conditions.
Walgreens will now have nearly 300 community-based specialty pharmacies nationwide, with more than 1,500 specialty-trained pharmacists, 5,000 patient advocacy support team members and dedicated Specialty360 teams that support all specialty conditions and therapies.
“With...
OIG contacts providers for CGM cost study
April 30, 2024HME News Staff
WASHINGTON – The Office of Inspector General has begun sending emails and letters to a select group of continuous glucose monitor (CGM) suppliers as part of an evaluation for its study "Medicare Payments Compared to the Prices Available to Consumers and Suppliers for Continuous Glucose Monitors and Sensors," AAHomecare reports.
This study aims to determine the cost-effectiveness of Medicare payments in comparison to the supplier’s acquisition costs and other prices available...
OIG publishes ‘Consumer Alert’ for cath scams
March 11, 2024HME News Staff
WASHINGTON – The Office of Inspector General is alerting the public about a fraud scheme involving urinary catheters. In a “Consumer Alert,” the agency says scammers are targeting Medicare enrollees through phone calls, Internet ads and text messages with offers of free services, medical equipment or gift cards upon confirming their personal information and eligibility for specific Medicare services. Often, the enticement for the individual is that they are “qualified”...
HHS-OIG details latest fraud activities
December 4, 2023HME News Staff
WASHINGTON – The HHS-OIG’s Fall 2023 Semiannual Report to Congress highlights more than $3.44 billion in expected recoveries resulting from audits and investigations conducted during fiscal year 2023.
In FY 2023, HHS-OIG reported 707 criminal enforcement actions against individuals and entities suspected of engaging in crimes targeting HHS programs and the people they serve. They also reported 746 civil actions, which include false claims and unjust-enrichment lawsuits filed...
OIG warns of RPM scam
November 27, 2023HME News Staff
WASHINGTON – The Office of Inspector General has posted a consumer alert about a fraud scheme involving monthly billing for remote patient monitoring. The OIG says unscrupulous companies are signing up Medicare beneficiaries for monitoring using medical devices like scales, glucose monitors, blood pressure cuffs, cardiac rhythm devices and other equipment, regardless of medical necessity. The agency says these companies are signing up bennies for these services in several ways, including phone...
OIG questions HHA fall reporting
September 11, 2023HME News Staff
WASHINGTON – Over half of the falls among Medicare home health patients hospitalized for falls with major injury were not reported on patient assessments by home health agencies (HHAs) as required, according to a new Office of Inspector General report. Due to this high rate of non-reporting, Care Compare may not provide accurate information about the incidence of these falls, the OIG says. Reporting on OASIS assessments was worse among younger home health patients (compared to older patients)...
Price substitution policy works, OIG says
September 5, 2023HME News Staff
WASHINGTON – Medicare and its enrollees have saved $73.4 million since 2013, because of CMS’s price substitution policy for Part B covered drugs, according to an August issue brief from the Office of Inspector General. They could have realized an additional $889,000 in savings in 2021, if CMS expanded the price-substitution criteria, the OIG says. When Congress established average sales prices (ASPs) as the basis for reimbursement for Medicare Part B drugs, it also provided a mechanism...
OIG: More oversight needed of Medicaid managed care
July 20, 2023HME News Staff
WASHINGTON – Some people enrolled in Medicaid managed care may not be receiving all of their medically necessary health care services, according to a new study from the Office of Inspector General.
There are three key factors causing concern, the OIG says: the high number and rates of denied prior authorization requests; the limited oversight of prior authorization denials in most states; and the limited access to external medical reviews.
What the OIG found
Overall,...
Viemed’s Casey Hoyt on win: ‘We had the confidence to fight’
January 27, 2023Theresa Flaherty, Managing Editor
LAFAYETTE, La. – Viemed Healthcare’s recent victory at the administrative law judge level of the Medicare appeals process is as much a win for the company as the HME industry, says CEO Casey Hoyt.
Earlier this month, an ALJ judge ruled in favor of Viemed, overturning all remaining disputed claims for non-invasive ventilation related to the findings of an Office of Inspector General report and ordering CMS to return 100% of the previously remitted funds to the company.
“DME...
OIG calls out unimplemented recommendations
December 19, 2022HME News Staff
WASHINGTON – The Office of Inspector General has published its annual “Top Unimplemented Recommendations: Solutions to Reduce Fraud, Waste and Abuse in HHS Programs” and DME makes more than one appearance.
This year, the OIG’s recommendations focus on the top 25 unimplemented recommendations that, in its view, would most positively affect HHS programs in terms of cost savings, program effectiveness and efficiency, and public health and safety if implemented.
Recommendations...