Medicare Contractor for Jurisdiction 10 Overpaid Providers for Selected Outpatient Drugs

摘要

The Centers for Medicare & Medicaid Services (CMS) pays Medicare claims through the Medicare administrative contractor or fiscal intermediary (Medicare contractor) in each Medicare jurisdiction. From July 1, 2009, through June 30, 2012, Medicare contractors nationwide paid hospitals $11.5 billion for outpatient drugs, which also include biologicals and radiopharmaceuticals. Previous Office of Inspector General reviews of outpatient services have found that Medicare contractors overpaid providers for selected outpatient drugs. This report is part of a series of reports focusing on payments for selected outpatient drugs. The objective of this review was to determine whether payments that the Medicare contractor for Jurisdiction 10 made to providers for selected outpatient drugs were correct. Providers report the outpatient drugs administered to Medicare beneficiaries using standardized codes called Healthcare Common Procedure Coding System (HCPCS) codes and report units of service in multiples of the units shown in the HCPCS narrative description.