Most PAP Resupply Claims Don’t Pass Medicare Muster

New report from HHS OIG says claims for replacement positive airway pressure device supplies didn’t comply with Medicare’s requirements.

Most Medicare claims that HME providers submitted for replacement positive airway pressure (PAP) device supplies did not comply with Medicare requirements, according to a new report from HHS Office of Inspector General.

In a sample of 110 claims that Medicare paid in 2014 and 2015, only 24 complied with Medicare requirements, while 86 claims with payments totaling $13,414 did not, according to “Most Medicare Claims for Replacement Positive Airway Pressure Device Supplies Did Not Comply With Medicare Requirements.” From there, HHS OIG extrapolated a considerable sum in non-compliant claims.

“On the basis of our sample results, we estimated that Medicare made overpayments of almost $631.3 million for replacement PAP device supply claims that did not meet Medicare requirements,” a statement from HHS OIG read.

The report chalked up the overpayments to insufficient CMS oversight of replacement PAP device supplies t to ensure the claims complied with Medicare requirements, as well as to prevent payment of those claims.

“Without periodic reviews of claims for replacement supplies, Medicare contractors were unable to identify suppliers that consistently billed claims that did not meet Medicare requirements or to take remedial action,” HHS OIG noted.

HHS OIG recommended that CMS recover the portion of the overpayments of $13,414 that are within the four-year reopening period. It also made recommendations that CMS should work more closely with the four Medicare contractors.

Learn more:
The complete HHS OIG report is available at bit.ly/2LQE0Uv, and a brief is available at bit.ly/2sWOb2P. Providers can also obtain copies of the report by contacting the Office of Public Affairs at Public.Affairs@oig.hhs.gov.

About the Author

David Kopf is the Executive Editor of HME Business and DME Pharmacy magazine. Follow him on Twitter at @postacutenews.

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