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Tuesday, August 7, 2012
by James Swann
Two Medicare contractors overpaid providers $2.2 million for the breast cancer drug Herceptin, the OIG said in two recent reports, and it's time to get that money back. The OIG looked at a sample of line items included in provider claims submitted between 2008 and 2010, and found that providers were billing Medicare for the entire contents of one or more vials of Herceptin rather than billing for the actual amount of the drug administered to the patient. In some cases, providers administered a dose of the drug to patients and threw out the rest of the vial, but billed Medicare as if the entire vial had been used. The OIG recommended that the two contractors, Novitas Solutions Inc. and Noridian Administrative Services, recover the overpayments and implement system edits to prevent future overpayments.
The two contractors covered different geographic territory during the three-year audit period, with Novitas responsible for Delaware, the District of Columbia, New Jersey, and Pennsylvania, and Noridian responsible for Minnesota. An official from the OIG told me that more OIG reports on Herceptin overpayments are coming.
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