The HHS' Office of Inspector General found that Medicare overpaid suppliers of inhalation drugs by $92.5 million in 2017.
The OIG's review, published Oct. 31, notes that the top three inhalation drug suppliers received 56 percent of total Medicare payments in 2017. A prior OIG review found that the top two suppliers of inhalation drugs generally complied with Medicare requirements, and the third was found to have some billing issues. However, the goal of this review was to determine if the billing issues were primarily caused by the suppliers that received the other 44 percent.
The review included 2.3 million claims, totaling $259.5 million, for inhalation drugs that 7,868 suppliers provided to Medicare beneficiaries during the audit period. The OIG then reviewed a random sample of 120 of the claims, for which Medicare paid 65 suppliers $121,185.
The review found that not all suppliers followed Medicaid requirements when billing for inhalation drugs.
According to the OIG, 81 of the 120 claims complied with Medicare, but 39 did not. Those that did not comply were either incomplete, invalid, missing detailed written orders, had an incomplete proof of delivery, incomplete refill requests or medical records were not provided.
The OIG estimated that $92.5 million paid to inhalation drug suppliers was ineligible for Medicare reimbursement and that Medicare contractor oversight was not sufficient to make sure suppliers complied with documentation requirements.
The OIG recommended CMS work with Medicare contractors to recover $36,825 in overpayments from the suppliers associated with the ineligible claims. It also recommended that CMS push Medicare contractors to expand their review of inhalation drug claims and provide additional training to them.
CMS agreed with the recommendations and is taking steps to implement them.
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