CMS In Brief

In a CMS-commissioned report released Nov. 7, the HHS Office of Inspector General found that suppliers’ improper billing of beneficiaries for non-mail order diabetes test strips contributed to a 33% increase in non-mail order test strip claims in competitive bidding areas from 2010-2011. During the same time period, less expensive mail order supplies were found to have decreased by 71%. OIG discovered that for 20% of the 211 beneficiaries reviewed for the report, suppliers had improperly billed Medicare for the non-mail order diabetes test strips in 2011, whereas beneficiaries reported having received the less expensive mail order test strips. In addition, 23% of beneficiaries reviewed by OIG reported supplier activities – such as waiving their co-payments and sending them unsolicited testing supplies – that OIG determined to be inappropriate. While OIG made no recommendations in the report, it noted that this information could be useful to CMS as the agency prepares to implement the national mail order competition for diabetes suppliers as part of it its durable medical equipment, prosthetics/orthotics and supplies competitive bidding program, projected to begin in 2013.

CMS released estimated payment rates for three new Category 1 CPT codes – totaling $833 in aggregate – related to...