NHIC Corp., the Jurisdiction A DME Medicare administrative contractor, might have paid out $39 million in inappropriate claims for blood glucose test strips and lancets in 2007, according to a report from the Office of Inspector General. Of 100 claims the OIG studied that fell under the "high utilization" designation, 30 were compliant while 70 did not meet documentation requirements. Fifty-five of the latter provided no reason for ordering additional supplies, and 24 lacked complete physician orders, the OIG said. In addition, 27 claims did not fulfill refill requirements.
The OIG said the 70 claims added up to $5,400 in inappropriate payments, a figure that was extrapolated to $39 million. In 2007, NHIC paid $95 million in high utilization claims, according to the report. The OIG recommended that NHIC put in place system edits to flag high utilization claims for the test strips and lancets, enforce documentation requirements and work with CMS to determine which claims warrant further review.