The Office of the Inspector General (OIG) has concluded from a three-year record review that the Centers for Medicare & Medicaid Services (CMS) improperly paid $34 million to durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) suppliers for items provided during inpatient stays at acute-care hospitals and other types of inpatient facilities during that time. Medicare should pay the inpatient facility, through its inpatient claim, for all items provided to a beneficiary, according to the OIG report.
The report is based on a review of Medicare Part B payments to suppliers for 120,614 claims for DMEPOS items provided to beneficiaries during inpatient service dates from January 1, 2015, through December 31, 2017. Claims for DMEPOS items that met certain conditions for pre-discharge delivery were excluded.
The report also stated that beneficiaries were held responsible for unnecessary deductibles and coinsurance of $8.7 million paid to the suppliers for the items.
The report continued that Medicare overpaid the suppliers because system edits that should have prevented or detected the overpayments were not adequate; if the system edits had been designed properly, since 2008 Medicare could have saved $223.1 million, and beneficiaries could have saved $56.3 million in deductibles and coinsurance.
The OIG recommended that CMS direct Medicare contractors to recover the overpayments, recommend that suppliers refund the deductible and coinsurance amounts that beneficiaries may have been incorrectly charged, identify and recover any improper payments to suppliers after the audit period, and seek the legislative authority to require suppliers to refund beneficiary payments and correct the system edits.
CMS concurred with all but one of the recommendations. Regarding the suggestion to seek legislative authority to require suppliers to make refunds to beneficiaries, CMS told the OIG that it will consider whether to include it in the president’s next budget.
To read the report, visit https://oig.hhs.gov/oas/reports/region9/91703035.pdf.
