HHS IG Plans Three Competitive Bidding-Related Program Reviews

The FY 2012 Work Plan from HHS’ Office of Inspector General calls for reviewing three aspects of the DME competitive bidding program including CMS’ process for conducting competitive bidding:

Competitive Bidding Process for Medical Equipment and Supplies

We will review the process CMS used to conduct competitive bidding and subsequent pricing determinations for certain DMEPOS items and services in selected competitive bidding areas under rounds 1 and 2 of the competitive bidding program. Federal law requires OIG to conduct postaward audits to assess this process. (MIPPA, § 154(a)(1)(E).) (OAS; W-00-11-35241; various reviews; expected issued date: FY 2012; new start)

Support Surface Pricing (New)

We will review supplier acquisition costs for support surfaces as compared to Medicare payment rates. We will also review whether competitive bidding rates have affected Medicare patients’ access to appropriate supplies and services. Support surfaces are a type of DME covered under Part B as a medical or other health service pursuant to the Social Security Act, § 1861(s)(6). We will review costs for low-air-loss and alternating-pressure seat cushions. (OEI; 00-00-00000; expected issue date: FY 2012; new start)

Medicare DMEPOS Competitive Bidding Program: Supplier Solicitation of Physician Prescribing

We will interview prescribing physicians to determine the extent to which suppliers participating in the competitive bidding program are soliciting physicians to prescribe certain brands or modes of delivery of covered items that are more profitable to suppliers. We will also examine billing patterns to identify changes resulting from competitive bidding. Federal law requires Medicare to establish a competitive bidding process for the purchase of selected DME items. Congress subsequently delayed implementation until 2011. (Social Security Act, § 1847.) The same section of law requires that OIG conduct reviews (including this evaluation) examining the competitive bidding process. (OEI; 06-11-00081; expected issue date: FY 2012; work in progress)

The complete HHS FY 2012 OIG Work Plan is attached below.

Work-Plan-2012