Report Materials
For calendar years 2010 and 2011, three selected suppliers submitted claims for diabetic testing supplies without the KL modifier in accordance with Medicare requirements. The three suppliers used company-owned vehicles to deliver diabetic testing supplies to Medicare beneficiaries, which during our audit periods did not meet CMS's definition of "mail-order item." This definition allowed the suppliers to bill Medicare for non-mail-order supplies when they had delivered supplies in company-owned vehicles and to receive a higher reimbursement. If CMS's definition of "mail-order item" had included supplies delivered in company-owned vehicles and required the suppliers to claim them as mail-order supplies (i.e., with the KL modifier), we determined that Medicare would have paid approximately $4.7 million for the supplies rather than $8.2 million. In addition, we determined that the three suppliers did not routinely waive beneficiaries' coinsurance for diabetic testing supplies.
Notice
This report may be subject to section 5274 of the National Defense Authorization Act Fiscal Year 2023, 117 Pub. L. 263.