Payments for Medicare Services, Supplies, and DMEPOS Referred or Ordered by Physicians-Compliance

Centers for Medicare & Medicaid Services requires that physicians and nonphysician practitioners who order certain services; supplies; and/or durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) be Medicare-enrolled physicians or nonphysician practitioners and be legally eligible to refer and order services, supplies, and DMEPOS (Patient Protection and Affordable Care Act § 6405). If the referring or ordering physician or nonphysician practitioner is not eligible to order or refer, then Medicare claims should not be paid. We will review select Medicare services, supplies, and DMEPOS referred or ordered by physicians and nonphysician practitioners to determine whether the payments were made 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	Payments for Medicare Services, Supplies, and DMEPOS Referred or Ordered by Physicians-Compliance	Office of Audit Services	A-09-17-03002; W-00-17-35748; W-00-22-35748	2024