OIG investigates results of South Florida DME supplier appeals
Healthcare Auditing Weekly, November 4, 2008
The OIG identified a weakness in the appeals process for durable medical equipment (DME) suppliers in South Florida, according to a report. http://www.oig.hhs.gov/oei/reports/oei-03-07-00540.pdf
Of the 491 DME suppliers who had their billing privileges revoked in March 2007, 243 appealed the revocation and 222 were reinstated into the program. Following the reinstatement, two-thirds, or 148, had their licenses revoked a second time.
Because no criteria are established for what evidence is required to issue a reinstatement, hearing officers reviewed all types of evidence: photographs, affidavits, utility bills, and leases, according to the report.
The OIG recommended CMS require a more critical review of evidence brought to the hearing officers in order to strengthen the appeals process.
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