Sleep Providers Told to Hunt Down, Refund Overpayments

June's HHS OIG report on PAP resupply overpayments has resulted in Medicare contractors asking some sleep providers to review claims going back over six years.

Two months after the HHS OIG released a report claiming that most sleep resupply claims don’t comply with Medicare requirements, Medicare contractors are beginning to ask some sleep providers to review claims going back over six years.  

Industry audit consulting firm The Van Halem Group (a division of VGM Group) is advising that those providers take a second look at the report and a deeper look into their claims.

“This is significant and could have a significant impact on these providers,” said Wayne van Halem, president and founder of The van Halem Group.
The report, “Most Medicare Claims for Replacement Positive Airway Pressure Device Supplies Did Not Comply With Medicare Requirements,” examined a sample of 110 claims that Medicare paid in 2014 and 2015 and found that only 24 complied with Medicare requirements, while 86 claims with payments totaling $13,414 did not.

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 van Halem group noted in a recent blog post that HHS OIG recommended in its report that Medicare contractors notify 82 suppliers associated with the 86 claims containing potential overpayments to investigate and return any overpayments.

“This month, suppliers are receiving the notices from Noridian and CGS advising them to ‘review claims submitted related to replacement PAP device supplies to determine if overpayments exist within the six-year lookback period,'” the post noted.

MACs are encouraging sleep providers to use statistical analysis to produce a valid data sample that can be extrapolated across its sleep resupply claims rather than review all the claims they billed over the last six years. Providers will have six months from the date of the notification letter to review their claims and identify any overpayments. If they find overpayments, they then have two months to report and refund those overpayments.

In its blog post, The van Halem Group encourage providers to thoroughly investigate their claims to ensure they are medically necessary and backed by the right documentation.

“Self-reporting an overpayment does not imply guilt or fraud, and will not leave you open to a barrage of future audits,” it read. “Should those claims be audited in the future, you will be afforded appeal rights, as you are with any overpayment claim.”

About the Author

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

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