Office of Inspector General Releases FY 2017 Work Plan for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies

PUBLISHED: Nov 21, 2016

The U.S. Department of Health and Human Services Office of Inspector General (OIG) issued its Work Plan for fiscal year (FY) 2017 summarizing new and ongoing reviews and activities that OIG plans to pursue with respect to HHS programs and operations during the current fiscal year and beyond. Today’s StayAlert! Notice reviews those aspects of the Work Plan specific to durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS)

Below is a summary of some of the areas that OIG will focus on for DMEPOS in 2017. See the OIG’s 2017 Work Plan for a complete listing of focus areas.

Medical Equipment and Supplies

  • NEW: Part B Services During Non-Part A Nursing Home Stays: Durable Medical Equipment: This study will determine the extent of inappropriate Medicare Part B payments for DMEPOS provided to nursing home residents during non-Part A stays in 2015. OIG will also determine whether CMS has a system in place to identify inappropriate payments for DMEPOS and recoup payments from suppliers.
  • NEW: Medicare Market Share of Mail-Order Diabetic Testing Strips: April 1 through June 30, 2016 – Mandatory Review: OIG is required to report the market share of diabetic testing strips (DTS) before each subsequent round of the competitive bidding program pursuant to section 1847(b)(I0)(B) of the SSA. This first data brief in a series of three will determine the market share of DTS for the 3-month period immediately preceding the implementation of the National Mail Order Recompete on July 1, 2016 (i.e., April through June 2016). The second report will be for the 3-month period immediately after implementation (i.e., July through September 2016). The third report will be for a similar time frame 6 months after implementation (October through December 2016). These data will help CMS determine how the National Mail Order Recompete may impact shifts in the market.
  • NEW: Positive Airway Pressure Device Supplies — Supplier Compliance with Documentation Requirements for Frequency and Medical Necessity: Beneficiaries receiving continuous positive airway pressure or respiratory assist device therapy (PAP) require replacement of the device’s supplies (e.g. mask, tubing, headgear, and filters) when they wear out or are exhausted. Medicare payments for these supplies in 2014 and 2015 were approximately $953 million. Prior OIG work found that suppliers automatically shipped PAP device supplies when no physician orders for refills were in effect. For supplies and accessories used periodically, orders or certificates of medical necessity must specify the type of supplies needed and the frequency with which they must be replaced, used, or consumed (CMS’s Medicare Program Integrity Manual, Pub. 100-08, Ch. 5, §§ 5.2.3 and 5.9). Beneficiaries or their caregivers must specifically request refills of repetitive services and/or supplies before suppliers dispense them (CMS’s Medicare Claims Processing Manual, Pub. 100-04, Ch. 20, § 200). OIG will review claims for frequently replaced PAP device supplies to determine whether documentation requirements for medical necessity, frequency of replacement, and other Medicare requirements are met.

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