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OIG Audit: Medicare Overpaid DMEPOS Suppliers for Items Provided to Hospice Patients

According to a new report from the HHS Office of Inspector General (OIG), Medicare improperly paid suppliers about $117 million for durable medical equipment, prosthetics, orthotics and supplies (DMEPOS) provided to hospice beneficiaries over four years.[1] When durable medical equipment is related to the palliation and management of a beneficiary’s terminal illness and related conditions as identified in the hospice plan of care, the hospice must include the cost of the items or services on claims. When they’re unrelated to the terminal illness and related conditions, the DMEPOS supplier may bill Medicare with modifier GW. For its audit, OIG selected two stratified samples of 200 DMEPOS line items. One had 115 DMEPOS items billed by suppliers without the GW modifier, and the other had 85 line items with the GW modifier. The findings: Medicare improperly paid DMEPOS suppliers for 121 items. Among other things, OIG recommended CMS improve prepayment edits, and CMS agreed.

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