OIG to review costs of ESRD drugs, questionable use of ambulance services to dialysis facilities

In fiscal year 2015, the U.S. Department of Health and Human Services Office of Inspector General will be examining the costs of end-stage renal disease drugs, and how they have changed, as well as review Medicare claims data to assess the extent of questionable billing for unnecessary ambulance transports to dialysis facilities, according to the OIG Work Plan.

ESRD drugs and services
OIG said it would review Medicare payments for renal dialysis services and related drugs under the ESRD bundled payment system. OIG said it will compare dialysis facilities' acquisition costs for certain drugs to inflation-adjusted cost estimates, and determine how costs for the drugs have changed. The Centers for Medicare & Medicaid Services has based the ESRD payment rate price updates on data from the Bureau of Labor Statistics, but OIG said it has previously found that the data did not accurately measure changes in dialysis facilities’ acquisition costs for expensive ESRD drugs.

Ambulance services
OIG said it would examine Medicare claims data to assess the extent of questionable billing for ambulance services, such as transports that potentially never occurred or potentially were medically unnecessary transports to dialysis facilities. OIG will also determine whether Medicare payments for ambulance services were made in accordance with Medicare requirements. -by Rebecca Zumoff