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||Centers for Medicare & Medicaid Services||Nebulizer Machines and Related Drugs - Supplier Compliance with Payment Requirements||Office of Audit Services|| A-09-16-02037;