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Project OAS-25-09-090

Announced on  | Last Modified on  | Project Number: OAS-25-09-090
Status
Active
Agency
Centers for Medicare and Medicaid Services

OBJECTIVE

Medicare requires providers to submit accurate claims for outpatient services, including drugs administered. Providers must use standardized codes, called Healthcare Common Procedure Coding System (HCPCS) codes, for drugs administered. Providers may be billing for administered drugs using HCPCS codes different from the ones assigned to the National Drug Codes (NDCs), which are unique numbers used to identify drugs in the United States. This means that they may be billing for drugs that were not the ones administered. We will identify whether there are potential vulnerabilities in Medicare’s oversight of providers’ billing of drugs with HCPCS codes that do not match those assigned to the NDCs listed on the claims.

Project titles will remain unpublished until projects are complete and reports are posted.

TIMELINE

  • June 17, 2025
    Announced
  • Today
    Office of Audit Services In-Progress
  • Est FY2027
    Estimated Fiscal Year for Project Completion
Work Plan Type
Office of Audit Services
HHS Agencies
Centers for Medicare and Medicaid Services
Issue Areas
Hospitals Prescription Drug
Target Groups
Elderly People With Disabilities
Financial Groups
Medicare B