Medicare Compliance & Reimbursement

Plus: Another fraud contractor arrives on the scene. If you thought the OIG wasn't looking at your claims from all possible angles, it's time to think again. A new OIG report, issued on April 22, notes that although only two percent of Medicare beneficiaries live in South Florida, "this area accounted for 17 percent of Medicare's total spending for inhalation drugs in 2007." More suspicious: The OIG found that the beneficiary listed on 62 percent of the S. Florida inhalation drug claims had not had a Medicare-billed office visit or other service over the previous three-year period with the physician who prescribed the medication. As a result of the OIG investigation, CMS was advised to ensure that its contractors enforce "the coverage guidelines for inhalation drugs, eliminate Medicare's vulnerability to potentially fraudulent or excessive inhalation drug claims in South Florida, and review cases where the DME supplier appears to be [...]