An HHS inspector general's office review of home blood-glucose test strip and lancet Medicare claims that were administered by Noridian Administrative Services, Fargo, N.D., found that about $30.9 million was inappropriately paid to providers.
HHS finds fault with Noridian payments
The inspector general's office found that Noridian did not have controls to ensure that claims for test strips and/or lancets complied with Medicare documentation requirements concerning high utilization claims and for identifying overlapping service dates for the same beneficiary, according to a report from the government office. “This billing pattern caused Noridian to allow payment for claims when beneficiaries had not nearly exhausted previously dispensed test strips and/or lancets,” according to the report.
Officials for Noridian, a Medicare administrative contractor, could not be reached for comment.
The inspector general's office recommends that Noridian create systems to ensure documentation requirements and identify overlapping dates of service. It also recommends Noridian identify durable-medical-equipment suppliers with a high volume of high utilization claims, perform prepayment reviews of those providers and refer them to the inspector general's office or the CMS.
The conclusions are based on a review of 100 sampled 2007 claims processed by Noridian, the MAC for durable medical equipment in “Jurisdiction D,” which includes 17 states in the Midwest and West, including California, as well as Alaska and Hawaii.
Noridian, in its response to the inspector general's office, concurred with the findings and outlined corrective actions it has taken or planned to take. Noridian also noted that it did not assume medical review activities for Jurisdiction D until March 2008.
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