OIG Eyes $39M in NHIC ‘Inappropriate’ Payments

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.