Review of District of Columbia Medicaid Durable Medical Equipment, Prosthetics, Orthotics, and Supplies Provider Enrollment Practices

摘要

Pursuant to its Medicaid State plan, the District provides durable medical equipment and prosthetics, orthotics and supplies (DMEPOS) for eligible beneficiaries through its Durable Medical Equipment (DME) program. The DME program reimburses DMEPOS providers that sell or rent to beneficiaries DMEPOS, including hospital beds, braces, home dialysis supplies and equipment, therapeutic shoes for diabetics, wheelchairs, walkers, scooters, oxygen equipment, and other home health care items. During the period January 1, 2007, through June 30, 2010, the District's DME program reimbursed providers approximately $50 million. To receive and maintain a District Medicaid provider billing number, providers must meet the standards established in Title 29 of the District of Columbia Municipal Regulations (DCMR). Pursuant to 29 DCMR section 996.2(k), providers in the District's DME program must be enrolled in the Medicare program. District regulations provide grounds for administrative sanctions against Medicaid DMEPOS providers that fail to comply with pertinent District laws and regulations. The sanctions may include termination of the providers for the DME program (29 DCMR section 1302.1(c)). As of March 2010 the District had 195 active DMEPOS providers enrolled in its Medicaid program. Our objective was to determine whether the State agency complied with District requirements when DMEPOS providers' Medicare supplier numbers had been revoked.