Previous audits from 2005 through 2016 have found that hospitals aren’t properly reporting credits they received from manufacturers for defunct cardiac devices.
In its most recent audit, the inspector general found hospitals likely didn’t adjust claims to include credits for recalled devices in nearly half of the 6,558 claims that the office reviewed. The inspector general said this likely led to $33 million in overpayments to 911 hospitals.
The office recommended several changes to CMS, including payment recovery and implementation of a postpayment review process for Medicare contractors. The agency also asked CMS to require hospitals to use specific condition codes on these types of claims.
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