OIG report addresses concerns over Medicare billing for ventilators

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The growing number of Medicare claims submitted for ventilators is likely being driven by three suppliers, the Department of Health and Humans Services' Office of Inspector General said in a data brief released Thursday.

The OIG conducted research into the “substantial increase” in Medicare claims for noninvasive pressure support ventilators in response to concerns about the billing raised by the Centers for Medicare & Medicaid Services. The office analyzed claims data on noninvasive multimodal ventilators, CPAP devices and respiratory assist devices from 2009 through 2015.

The cause of the significant claims increase wasn't, as the OIG had theorized, due to reduced prices for CPAP and RAD devices, or a large number of beneficiaries switching to the more expensive multimodal ventilators.

Instead, three national suppliers have “rapidly expanded their market share” and accounted for 54% of all growth in beneficiaries with claims for multimodal ventilators between 2012 and 2015. There was also a “dramatic shift” in the use of such ventilators to treat respiratory conditions, the OIG said.

The data brief should give CMS “useful contextual information” as it works to refine its program integrity efforts around ventilator billing, the OIG said. Among the brief's suggestions for CMS is focusing its efforts on monitoring providers with large market shares, and further exploring the causes and implications of the shift in beneficiary conditions.