OIG Audit Finds $22.7 Million in Medicare Overpayments for DME
The Department of Health and Human Services (“HHS”) Office of Inspector General (“OIG”) issued a final report finding that Medicare improperly paid suppliers of durable medical equipment, prosthetics, orthotics, and supplies (“DMEPOS”) for items provided to enrollees during inpatient stays. According to the OIG, Medicare is not responsible for reimbursing suppliers for DMEPOS items furnished while a beneficiary is an inpatient; instead, these items should be supplied by the inpatient facility or under an agreement between the facility and the supplier. As a result, none of the $22.7 million in payments for these items and services should have been made. The OIG recommended that the Centers for Medicare & Medicaid Services (“CMS”) direct DME Medicare contractors to recover the full amount of the overpayments from suppliers.
CMS Issues Notice to MACs Lifting Certain Medicare Claims Holds, Keeping Others
CMS published a newsletter instructing all Medicare Administrative Contractors (“MACs”) to lift claims holds for services impacted by the government shutdown that were provided on or after October 1, 2025. This directive applies to claims paid under the Medicare Physician Fee Schedule, ground ambulance transport claims, and Federally Qualified Health Center (“FQHC”) claims. CMS has instructed MACs to release and process claims for telehealth services related to behavioral and mental health care. However, claims holds will remain in place for other telehealth services and for acute Hospital Care at Home claims.
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