OIG Agrees to Perform Study on Medicare Beneficiary Access to DME

WASHINGTON (Jan. 09, 2015)—The Department of Health & Human Services’ Office of the Inspector General (OIG) has agreed to perform a study on Medicare beneficiary access to DME requested by a bipartisan coalition of House members in July. 

The American Association for Homecare released an industry alert containing the contents of the letter received by the office of Rep. Tom Price, R-Ga. “We appreciate Dr. Price spearheading this effort and we feel confident that the access issues we have been talking about all along will be uncovered by this process,” remarked Tom Ryan, AAHomecare president & CEO. “AAHomecare will continue to work with Dr. Price, the OIG, and other members of Congress on this issue.” 

The text of the letter follows.

__________________________________

Department of Health & Human Services

Office of the Inspector General

Washington, DC 20201

December 22, 2014

The Honorable Tom Price, M.D.

House of Representatives

Washington, DC 20515

Dear Dr. Price:

I am writing in response to your July 25, 2014, letter in which you and 137 of your colleagues asked the Office of Inspector General (OIG) to conduct a study of the impact on senior health of the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) competitive bidding (CB) program and the National Mail Order Program for diabetic testing supplies, as implemented in Round 1 Recompete, Round 2, and the Round 1 Rebid. My staff has had ongoing conversations with your staff regarding this request. As discussed with your staff on October 15, this letter memorializes the work that OIG is undertaking pursuant to your request.

OIG will commence a study to determine the effects of the CB program on Medicare beneficiaries’ access to durable medical equipment subject to competitive bidding. We plan to review documents from providers and Medicare claims data for a nationally representative sample of beneficiaries to determine and compare the rates at which beneficiaries successfully obtained needed items subject to competitive bidding. For a purposive sample of cases when beneficiaries appear not to have received needed items, we plan to explore why they did not receive the items. We will keep you apprised of status as this work progresses.

OIG has several additional reviews either completed or underway that relate to concerns raised in your letter. OIG is conducting alimited-scope review in 11 States related to allegations that unlicensed suppliers received contracts under Round 2 of the CB program. This limited-scope review will determine how the Centers for Medicare &Medicaid Services (CMS) applied State licensing requirements under Round 2 in these States to suppliers that were awarded contracts.

In addition, the Medicare Improvements for Patients and Providers Act (MIPPA) of 2008 requires that OIG conduct apost-award review of CMS’s CB program after implementation of Rounds 1 and 2 of the bidding. We have finalized our review of Round 1* and will commence work this year to incorporate apost-award review of Round 2. This work will determine whether CMS selected DMEPOS suppliers computed the single payment amounts and pivotal bid amounts in the Round 2 program in accordance with Federal requirements. The review will also incorporate licensure issues depending upon what is found in our limited-scope review, as described above.

We have completed additional work on Medicare market shares of mail order diabetic testing strips.** We are happy to brief you on these or any other OIG reviews that may be of interest. Should you have any questions, please contact me or your staff may contact Chris Hinkle, Director of Congressional and Regulatory Affairs, at 202-401-2206 or [email protected].

Sincerely,

Daniel R. Levinson

Inspector General