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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)
Nov-16 Centers for Medicare & Medicaid Services Payments for Medicare Services, Supplies, and DMEPOS Referred or Ordered by Physicians-Compliance Office of Audit Services W-00-17-35748 2019