The Office of Inspector General (OIG) recently conducted a review of contractors that process claims for home blood-glucose test strip and lancet supplies. Medicare Part B covers test strips and lancets prescribed by physicians for diabetics. This coverage depends on beneficiaries’ usual medical needs.
After analyzing the relevant data, OIG estimated that contractors improperly allowed payment of approximately $271 million in high utilization claims for lancets and/or test strips. Within this amount, OIG estimated that $209 million was improperly paid to suppliers.
Deficiencies found by OIG included (1) the quantity of supplies that exceeded utilization guidelines was not supported with documentation that specified the reason for the additional supplies, the actual frequencies of testing, or the treating physicians’ evaluation of the patients’ diabetic control within 6 months before ordering the supplies; (2) there was no supporting documentation that indicated refill requirements had been met; (3) physician orders were missing or incomplete; or (4) proof-of-delivery records were missing.
Based on the results of this study, OIG made recommendations to ensure that Medicare rules are enforced with respect to the payment of claims for test strips and lancets.
A complete copy of this report can be found here:
https://oig.hhs.gov/oas/reports/region9/91102027.pdf.
The United States Department of Justice aggressively pursues companies that improperly bill Medicare for diabetic supplies. An example of this policy protecting taxpayer funds is reflected in the government’s case against Ammed Direct LLC, a False Claims Act lawsuit in which Barrett Law Office, PLLC represented the whistleblower. For more information on this case, please see the following press release from the Department of Justice: “Ammed Direct LLC to Pay $18 Million to United States and Tennessee to Resolve False Claims Allegations” (http://www.justice.gov/opa/pr/2012/April/12-civ-474.html)