Thursday, August 29, 2013

Florida leads nation in another type of inappropriate Medicare billing

Florida health care firms have added a new category of inappropriate Medicare billing to lead the nation in: diabetes test strips.
South Florida was already notorious for nation-leading Medicare fraud in areas like durable medical equipment, mental health centers, prescription drugs, HIV infusion and home health. Now the drain on taxpayers has apparently expanded to another area.
The new report by the Department of Health and Human Services’ Office of Inspector General found a startling amount of the “inappropriate and questionable” Medicare billing in Florida by diabetes test strip (DTS) suppliers in 2010 and 2011.
The Port St. Lucie/Treasure Coast area led the nation with $115 million in questionable DTS billing, with South Florida in second at $113.1 million. They combined for 54 percent of the national total in questionable DTS billing.
After Nashville and New York, the Tampa Bay area placed fifth at $14.2 million.
In the Treasure Coast, 11 of the 79 total DTS suppliers had questionable billing. One provider on the Treasure Coast accounted for the majority of that, $114.7 million.
In South Florida, it was 222 of the 1,125 DTS suppliers who had questionable billing.
The OIG report didn’t identify any suppliers by name, but it gave a few interesting tidbits. One Miami DTS provider stood out for having over four types of questionable billings and $14 million in allowed claims. A Fort Lauderdale supplier ordered 14,741 DTS for store pickup for beneficiaries who lived more than 20 miles away, for a total of $2.3 million in Medicare claims.
Of the 10 suppliers with the highest amount of questionable DTS billing in the nation, the big one on the Treasure Coast tops the list and five from South Florida joined it, including the No. 2 supplier with $19.9 million in questionable billings. A Tampa-area DTS supplier also made the Top 10, giving Florida seven spots.
The OIG said it referred the problematic suppliers to regulators for further action.
Overall in 2011, Medicare paid $1.1 billion in claims for DTS for 4.6 million beneficiaries. Starting in 2011, Medicare put all mail-order DTS in a competitive bidding program in large metro areas, including South Florida. Store bought DTS are not in that program.
The OIG study found that Medicare paid $6 million in clearly unallowable DTS bills plus another $425 million in highly questionable bills. About 10 percent of DTS suppliers had a billing problem.
Reasons that the OIG study considered the DTS claims inappropriate or questionable include them being for a patient without a diagnosis for diabetes, overlapping with an inpatient hospital or nursing home stay, billing for an unusually high number of strips per patient, or billing patients who lived far away from the DTS store. In some cases, suppliers gave beneficiaries “free” DTS and billed Medicare for them, or mailed them DTS but billed Medicare for the more expensive store-bought service, the OIG reported.
The OIG report recommended that Medicare increase its monitoring of DTS suppliers.

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