Tag: Office of Inspector General (OIG)
In brief: Medicare spending, OIG savings, telehealth flexibility, cath reviews
December 11, 2024HME News Staff
WASHINGTON – Medicare spent 27% more, on average, for people who were covered by traditional Medicare after disenrolling from Medicare Advantage than for people who were continuously covered by traditional Medicare, after adjusting for differences in health status and other characteristics, according to a new analysis by the Kaiser Family Foundation.
This is a difference of $2,585 in Medicare spending per person, on average, between the two groups in 2022.
Other highlights...
HHS-OIG highlight $7B in savings in new report
December 9, 2024HME News Staff
WASHINGTON – The Fall 2024 Semiannual Report to Congress (SAR) highlights more than $7 billion in expected recoveries and receivables resulting from HHS-OIG investigations and audits conducted during fiscal year 2024. HHS-OIG reported 1,548 criminal and civil enforcement actions in FY 2024 against individuals and entities suspected of engaging in crimes targeting HHS programs and the people they serve, including settlements resulting from using OIG's civil monetary penalty authorities...
OIG adds reviews for wheelchair repairs, oxygen
October 31, 2024HME News Staff
WASHINGTON – The Office of Inspector General added wheelchair repairs and oxygen and oxygen equipment to its work plan in October. For wheelchair repairs, the OIG will examine suppliers who provide these services and will consider the duration of repairs, their implementation of selected quality standards, and their identification of deficiencies related to wheelchair repairs. It will review documentation from wheelchair suppliers and accreditation organizations and conduct interviews with...
OIG to Medicare: Adjust allowables for orthotic devices
October 21, 2024HME News Staff
WASHINGTON – The Office of Inspector General has included on its “Top Unimplemented Recommendations” list a recommendation that Medicare review Medicare allowable amounts for 161 orthotic device HCPCS codes that it says the agency and its beneficiaries have paid an estimated $337.5 million more for than select non-Medicare payers. The OIG also recommends that Medicare adjust the allowable amounts, as appropriate, using regulations promulgated under existing legislative authority...
OIG: More oversight needed of remote patient monitoring
September 25, 2024HME News Staff
WASHINGTON – CMS needs to provide more oversight of remote patient monitoring to ensure it is being used and billed properly, says a new report from the Office of Inspector General.
From 2019 to 2022, use of remote patient monitoring increased dramatically, from about 55,000 enrollees to 570,000. In 2022, payments for these services by traditional Medicare and Medicare Advantage were more than $300 million, compared to just $15 million in 2019.
However, the OIG found 43% of...
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...