WASHINGTON -- The federal government paid $107 million last year in questionable Medicare charges for supplies used by incontinent nursing home patients, the Department of Health and Human Services inspector general said yesterday.
graflead,1 June Gibbs Brown said 20 separate investigations targeting about 100 subjects have been merged into a single criminal investigation.
"Incontinence suppliers are out of control," Ms. Brown said at a breakfast with reporters.
Incontinence supplies include catheters and urinary collection pouches and accessories such as irrigation syringes, sterile saline solutions and lubricants.
From 1990 to 1993, Medicare payments for such supplies more than doubled -- from $88 million to $230 million -- while the number of beneficiaries receiving them declined from 312,000 to 293,000.
More than half of the payments in 1993 -- 56 percent -- were made by Blue Cross/Blue Shield of Florida, which acted as the paying agent for Medicare claims filed in Florida, Ms. Brown said. The paying agent is supposed to reject improper or fraudulent claims.
The federal probe focuses on fewer than two dozen of the more than 470 incontinence equipment suppliers. Those suppliers accounted for more than three-fourths of the Medicare claims.
The probe also covers an undetermined number of nursing homes that may have conspired with suppliers to submit fraudulent billings or purchase unnecessary supplies paid for by the government.
Under Medicare rules, the government will pay for incontinence supplies only for patients who have a prosthetic device.
Of the $107 million in questionable billings, Ms. Brown said about $88 million was for supplies billed to patients who did not have a prosthetic device and another $19 million was for excessive supplies for patients with a prosthesis.
In many cases, patients were unaware that they were being billed for the supplies because the suppliers waived the 20 percent co-payment required for Medicare services.