Moving the HME Industry Forward

Billing/Reimbursement

Diabetes Test Strips in the Spotlight

March 24, 2014

AMARILLO, TX – Anytime the OIG takes the time to shine a “spotlight” on something, it is important to take notice. From time to time, the OIG publishes “Spotlight Articles,” which address certain programs, practices, and products that have made it onto the OIG’s radar. On occasion, these articles have addressed issues related specifically to the DME industry. For instance, the OIG turned the spotlight on power wheelchairs in an article published during the summer of 2011.

Most recently, the OIG published an interesting spotlight article related to diabetes test strips. The March 18th article serves as an important reminder to suppliers of diabetes test strips that the OIG watches their patterns and practices closely. In addition to serving as a general reminder, the article points out three specific areas of concern that warrant greater attention and oversight.

The first area of concern pointed out is improper payments. The OIG states that it recently reviewed 400 diabetes test supply claims, and it asserts that over 75% of those claims had at least one deficiency in the supporting documentation. While hyper-technical reviews of claim documentation by auditors are nothing new to suppliers of any product line, this is an important reminder that one can never have too much documentation.

The second area of concern mentioned is questionable billing practices. The OIG gives examples of questionable billing practices, such as (1) the submission of multiple claims for the same patient by the same supplier in overlapping time periods and (2) the submission of non-mail-order claims for patients living an unusually long distance from the supplier.

It is no surprise that Medicare will only pay for test strips at designated intervals, and that Medicare will only pay for mail-order test strips furnished by one of the very few holders of a mail-order competitive bidding contract . Therefore, know that if there are questionable billing practices that could indicate violations of rules such as these, even this kind of circumstantial evidence is enough to lead auditors or, even worse, the OIG to your door.

Finally, the OIG points out that it is concerned with the price being paid by state Medicaid programs for diabetes test strips. More and more states are beginning to consider and implement their own competitive bidding programs, and test strip suppliers must keep apprised of such developments.

The article starts and ends with the OIG’s reiteration that it “uses a wide arsenal of enforcement actions to fight fraud associated with diabetes supplies,” and that it “will continue to fight the fraud, waste, and abuse associated with [them].” Therefore, take notice, and do not become the target of an enforcement action, as such actions can lead to things such as overpayments, exclusions, loss of licensure, or even criminal prosecution.

Todd A. Moody, JD, is an attorney with the Health Care Group at Brown & Fortunato PC, a law firm based in Amarillo, Tex. He represents DME suppliers, pharmacies, infusion companies, and other health care providers throughout the United States. Moody can be reached at (806) 345-6343 or tmoody@bf-law.com.