Medicare Compliance & Reimbursement

Plus:  OIG offers opinion on physician's office housing a DME supplier.

Medicare could save $285 million per year if it cracked down on chiropractors billing for services that don't meet requirements, according to the HHS Office of Inspector General. In particular, the Centers for Medicare & Medicaid Services should keep chiropractors from billing for non-covered maintenance services, which accounted for $186 million in unallowed payments in 2001.

The OIG published its 2006 Red Book, a compilation of recommendations that could save Medicare and other programs money. Other recommendations included cracking down on podiatrists' inappropriate nail debridement services, encouraging the carriers to impose a "least costly alternative" policy on Lupron, and reviewing Part B therapy services.

DME Suppliers And Physicians Shouldn't Go Into Business Together, OIG Warns

A proposed deal in which a durable medical equipment supplier would provide DME to a physician could potentially violate the federal anti-kickback statute, the HHS Office of Inspector General said in Advisory Opinion 06-02.

The deal would have allowed the physician to become a DME supplier for non-Medicare patients, and the DME supplier would have rented space in the physician's office to supply DME directly to the physician's Medicare patients. The DME supplier would have paid rent, plus a percentage of revenues from DME sales and rentals. A trained professional would have been on-site to fit and supply the DME to the patients.

Both programs, taken together, pose a "significant risk of fraud and abuse," concluded the OIG.