OIG still wants Medicare bad-debt policy modified

For one reason or another, the Centers for Medicare and Medicaid Services (CMS) and other agencies within the U.S. Department of Health and Human Services don't always implement the recommendations that the Office of Inspector General (OIG) makes as a result of its audits and investigations. Seven "priority recommendations" for the traditional fee-for-service Medicare programs (Part A and Part B) remained unimplemented as of Sept. 30, 2009, according to the annual report, "Compendium of Unimplemented Office of Inspector General Recommendations." The OIG considers these recommendations, which include both monetary and nonmonetary issues, a priority because "in our view they represent the most significant opportunities to positively impact [the fee-for-service] programs." Here are the top outstanding recommendations that the OIG wants addressed:

  • Hospitals: Modify policy to reduce or eliminate Medicare payments for hospital bad debts. Estimated savings: $340 million. (This is one of seven unimplemented Medicare recommendations related to hospitals that the OIG still champions.)
  • Nursing homes: Ensure the appropriate processing of denial of Medicare payment remedies for noncompliant nursing homes. Nonmonetary.
  • Hospices: Ensure that hospice claims for beneficiaries in nursing facilities comply with Medicare coverage requirements. Nonmonetary.
  • Practitioners: Adjust eye global surgery fees to reflect the number of evaluation and management services actually being provided by physicians. Estimated savings: $97.6 million.
  • Medical equipment and supplies: Ensure medical equipment suppliers' compliance with Medicare enrollment standards. Estimated savings: to be determined.
  • Medical equipment and supplies: Reduce the rental period for Medicare home oxygen equipment. Estimated savings: $3.2 billion.
  • Medical equipment and supplies: Eliminate Medicare's vulnerability to fraudulent or excessive inhalation drug claims in south Florida. Estimated savings: to be determined.

To learn more about the unimplemented recommendations:
- read the OIG report