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Nebulizer Machines and Related Drugs - Supplier Compliance with Payment Requirements

A nebulizer machine changes medication from a liquid to a mist so that it can be more easily inhaled into the lungs. For CY 2014, Medicare paid approximately $632.8 million for inhalation drugs. Medicare requires that claims for nebulizer machines and related drugs be "reasonable and necessary" (SSA § 1862(a)(1)(A)). Further, the local coverage determinations issued by the four Medicare contractors that process medical equipment and supply claims include utilization guidelines and documentation requirements. A preliminary OIG review identified that at least 50 percent of claims reviewed were not paid in accordance with Medicare requirements. We will review Medicare Part B payments for nebulizer machines and related drugs to determine whether medical equipment suppliers' claims for nebulizers and related drugs are medically necessary and are supported in accordance with Medicare requirements.

Announced or Revised Agency Title Component Report Number(s) Expected Issue Date (FY)
Completed (partial) Centers for Medicare & Medicaid Services Nebulizer Machines and Related Drugs - Supplier Compliance with Payment Requirements Office of Audit Services A-09-16-02037, W-00-15-35465 2019