WASHINGTON--Medicare claims from home medical equipment providers--including those related to power wheelchairs and those from providers in South Florida--will come under increased scrutiny from the Office of Inspector General next year, according to a work plan released last week.

Each year, the OIG, which was created by Congress to help maintain the integrity of services provided by the Department of Health and Human Services, compiles a list of issues related to health care on which to focus in the coming year. The portion of the 2008 list addressing Medicare includes 12 sections, among them HME and supplies. The list also includes sections directed at Medicaid and other CMS-related issues and investigations.

"Through our previous work, we have identified management and performance challenges facing the Medicare and Medicaid programs, most significantly oversight of Medicare Part D, integrity of Medicare payments, appropriateness of Medicaid payments, Medicaid and SCHIP administration, and quality of care in institutional and community-based settings," the OIG said.

The work plan lays out several areas related to HME that the OIG intends to focus on through audits, evaluations and inspections. The following areas are slated for review:

  • Medicare claims for DME, prosthetics, orthotics and supplies furnished to beneficiaries receiving home health agency services. "Based on OIG interviews with home health patients, there were indications of unnecessary DME being ordered for beneficiaries receiving home health services," the OIG noted.
  • Appropriateness of Medicare payments to DME suppliers that submitted claims with modifiers. On review, several regional carriers that processed the DME claims "found that suppliers had little or no documentation to support their claims," the OIG reported. "This suggests that many of the claims submitted may have been invalid and should not have been paid by Medicare."
  • Appropriateness of Medicare Part B payments for home blood glucose test strips and lancet supplies.
  • Comparison of prices for negative pressure wound therapy pumps. "We will assess the range of supplier purchase prices for the pump to determine how Medicare reimbursement compares to the median supplier purchase price," the OIG said, noting that between 2001 and 2006, Medicare payments for the pump rose 624 percent. A recent OIG study found that 24 percent of pump claims did not meet Medicare coverage criteria.
  • Payment suspensions for medical equipment suppliers. The OIG will seek to determine if CMS has inappropriately made payments to suspended or excluded DME suppliers; it will also assess the agency's safeguards to prevent such payments.
  • Adequacy of medical records and other supporting documentation used by the Comprehensive Error Rate Testing program. The OIG will consider appropriateness of payments for such items as power wheelchairs, orthotics and other supplies; whether documentation supports the claims; whether the items were medically necessary and/or whether beneficiaries actually received them.
  • Appropriateness of Medicare reimbursement for pressure-reducing support surfaces.
  • Medicare payments for power wheelchairs. The OIG will review documentation supporting claims for power wheelchairs to determine if Medicare beneficiaries received the required face-to-face examinations prior to receipt of the wheelchairs.
  • Supplier purchase prices for power wheelchairs. The OIG said it will "determine the difference between the Medicare fee schedule for power wheelchairs and suppliers' invoice prices."

In addition, the OIG said it will continue to review claims submitted by South Florida DME providers. In a report released earlier this year, a review of DME suppliers in three South Florida counties found that 31 percent did not meet selected Medicare supplier standards.


The 2008 work plan also includes reviews of nursing home DME and enteral nutrition.

Results of the reviews will appear in its annual report to Congress next year, although some could appear in its 2009 report, the OIG said.

Read the work plan in full.