The United States Department of Health and Human Service’s (HHS) Office of Inspector General (OIG) recently released a report that states most Medicare claims from durable medical equipment supplies for payment for replacement positive airway pressure (PAP) device supplies were not in compliance with Medicare requirements.
As a result, the agency has requested suppliers review claims and return any overpayments.
Details of the OIG report
The report, Most Medicare Claims for Replacement Positive Airway Pressure Device Supplies Did Not Comply With Medicare Requirements, reviewed 110 claims from 2014 and 2015. Of these claims, authors with the report found 86 resulted in $13,414 in payments to suppliers that did not comply with Medicare requirements. Extrapolating from this relatively small sample size, the authors of the report estimate the HHS paid over $631.3 million in claims that did not meet Medicare requirements.
Ultimately, the report above calls for a review of all payments made in these types of claims and will likely involve a six year look back period. This review could lead to the agency demanding payment from suppliers who received payment from claims filed with Medicare.
Options for health care providers accused of an overpayment from Medicare
Those who receive such notification have options. One option is to file a Medicare and commercial carrier appeal. This process can result in a redetermination or reconsideration of the overpayment allegation. The appeals process can lead to a hearing and potential litigation in a federal court. As such, it is often wise to seek the legal counsel of an attorney experienced in overpayment appeals to better ensure your rights are protected.