End State Renal Disease Pricing Errors at Independent Facilities - AdminaStar Federal, Inc., Indianapolis, Indiana

EXECUTIVE SUMMARY:

The objective of this audit was to determine the extent of Medicare overpayments made to independent End Stage Renal Disease (ESRD) providers resulting from AdminaStar Federal's reimbursement of supplies used to administer separately billable injectable drugs.  AdminaStar Federal overpaid independent ESRD facilities as much as $407,300 relative to our universe of 6,756 ESRD billable lines of service processed during the period January 1, 1999 through December 31, 2001.  Independent ESRD facilities are limited to a $0.50 supply reimbursement per administration of separately billable drugs.  All of the 6,756 billed lines in our universe were amounts that exceeded this mandated limit.  We recommended that AdminaStar recalculate the Medicare reimbursement for billed services in our universe and initiate recovery actions on identified overpayments, and strengthen their procedures for loading HCPCS codes into the claims processing system.  AdminaStar concurred with our finding and recommendations.