The Medicare program could have saved an estimated $92.5 million in 2017 because a lack of oversight of contractors led to significant overpayment for inhalation drugs.
The Department of Health and Human Services Office of Inspector General came to that conclusion after reviewing how well suppliers complied with Medicare requirements when billing for inhalation drugs. The use of nebulizers and inhalation drugs, which are covered under Medicare Part B, may be a reality for many seniors.
The OIG’s review covered 2.3 million claim lines that totaled $259.5 million paid to suppliers for inhalation drugs for Medicare beneficiaries. The agency used a sample size of 120 claim lines, which Medicare paid $121,185 to 65 suppliers.
Of the 120, some 39 claims lines did not comply with Medicare requirements for billing inhalation drugs. Based on the sample, the agency estimated the Medicare program wrongly paid $92.5 million to suppliers.
“Medicare contractor oversight was not sufficient to ensure that suppliers complied with documentation requirements,” the report stated.
The agency recommended that the Centers for Medicare & Medicaid Services seek to recover overpayments made to the 39 suppliers; expand its review of suppliers’ claims to include additional inhalation rugs; and provide additional training to suppliers on Medicare documentation requirements for inhalation drugs.
It also recommended that the agency identify suppliers that consistently bill for inhalation drugs and don’t comply with Medicare documentation requirements.
CMS agreed with the recommendations and said it’s taking actions to address the concerns.