Medicine/Drugs

Medicare Needs to Do More to Cut Test Strip Overbilling

The Medicare program needs to do more to prevent questionable billing for diabetes test strips, according to a new report. An audit of billing practices by the Centers for Medicare and Medicaid Services found that the agency had doled out $425 million for questionable bills from a handful of test strip suppliers in 2011, and dished out $6 million for test strip billing to beneficiaries who lacked a proper diagnosis code, according to a report at Modernhealthcare.com.

The report, prepared by the Inspector General of the U.S. Department of Health and Human Services, found that most of the questionable bills went to about 10 percent of test strip suppliers centered in 10 states (Arizona, California, Florida, Kansas, Mississippi, Missouri, New Jersey, New York, Pennsylvania and Tennessee, if you’re keeping score at home). The Inspector General recommended that the agency monitor the billing process more closely to look for bills lacking proper diagnostic codes or overlapping with hospital or nursing home stays.

There was a spot of good news in the report for Medicare officials, however. The Inspector General’s report did say that Medicare’s new competitive bidding process for mail-order diabetes supplies has curbed the amount of fraudulent billing for diabetes test strips (see Insulin Nation’s “Reimbursement Changes Rattle Diabetes Medical Industry”). The competitive bidding process is expected to slash the government’s reimbursement rate for such supplies by up to 72%. It also has winnowed down the number of diabetes mail-order companies, making oversight of the billing process that much easier.  

Craig Idlebrook is a past editor for Insulin Nation, Type 2 Nation, and Información Sobre Diabetes. He is now the community engagement and content manager for T1D Exchange.

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