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Twenty Percent of DME Suppliers Non-Compliant When Billing Medicare

by | Jun 2, 2022 | Articles, News, Open Content

OIG report finds that $8 million of $40 million in claims made by such suppliers in a recent audit did not meet Medicare requirements.

According to a new report on an audit by the U.S. Department of Health & Human Service’s (HHS’s) Office of Inspector General (OIG), a sizable chunk of durable medical equipment suppliers did not comply with Medicare requirements when billing the federal healthcare insurance program for power mobility device (PMD) repairs. Of the $40 million in total that Medicare paid for such repairs during the audit period from October 1, 2018 through September 30, 2019, $8 million was found to be improperly paid.

The audit report, which was released in May, found:

  • Suppliers complied with requirements for 637 of the 922 PMD repairs associated with the 100 sampled beneficiaries
  • Suppliers were not compliant with requirements in 261 PMD repair submissions
  • The remaining 24 PMD repair submissions weren’t reviewed, but treated as “non-errors because they were under contractor review,” the OIG stated

Specific problems with the non-compliant submissions included:

  • Documentation not supporting charges for PMD repairs
  • Not documenting the labor time involved with the PMD repairs
  • PMD charges that were not necessary and reasonable

In addition to those non-compliance issues, the OIG found issues that weren’t necessarily non-compliant, but questionable in 183 PMD repairs associated with 19 sampled Medicare beneficiaries.

The OIG said they performed this audit due to an earlier review of claims made for 2006 through 2008 for capped rental durable medical equipment (DME) that found roughly $26.8

million worth of DME claims did not meet Medicare requirements. Certain PMDs are included in the DME category. The OIG wanted to see if such billing problems were still happening. Based on this new report, it appears non-compliance is still an issue, at least when it comes to billing for PMD repairs specifically.

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