Results of Reviews at Three Suppliers of Diabetic Testing Supplies
Fraud and waste associated with the billing of diabetes supplies has become so prevalent that OIG is taking a multi-pronged approach to fight it - focusing on prevention efforts as well as calling upon a wide arsenal of enforcement actions.
For calendar years 2010 and 2011, three selected suppliers submitted claims for diabetic testing supplies without the KL modifier in accordance with Medicare requirements. The three suppliers used company-owned vehicles to deliver diabetic testing supplies to Medicare beneficiaries, which during our audit periods did not meet CMS's definition of "mail-order item." This definition allowed the suppliers to bill Medicare for non-mail-order supplies when they had delivered supplies in company-owned vehicles and to receive a higher reimbursement. If CMS's definition of "mail-order item" had included supplies delivered in company-owned vehicles and required the suppliers to claim them as mail-order supplies (i.e., with the KL modifier), we determined that Medicare would have paid approximately $4.7 million for the supplies rather than $8.2 million. In addition, we determined that the three suppliers did not routinely waive beneficiaries' coinsurance for diabetic testing supplies.
Filed under: Center for Medicare and Medicaid Services