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Medicare Contractors Nationwide Overpaid Millions to Providers for Full Vials of Herceptin.

机译：医疗保险承包商全国多付了数百万美元给供应商提供全瓶赫赛汀。

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Herceptin, also known as trastuzumab, is a Medicare-covered drug used to treat breast cancer that has spread to other parts of the body and is supplied in a multiuse vial containing 440 milligrams. For multiuse vials, Medicare pays only for the amount administered to a beneficiary and does not pay for any discarded drug. In recent years, the Office of Inspector General (OIG) has conducted several audits that, among other things, found that overpayments were made on claims for full vials of Herceptin. On the basis of these reviews, we performed a pilot review that focused specifically on payments for full vials of Herceptin by a Medicare contractor. This pilot review found that $3.3 million, or 78 percent, of the payments that the contractor made to providers were incorrect. Because of the significant error rate of this pilot review, we expanded our review of the billing for Herceptin to include reviews at all Medicare contractors nationwide. Our objectives were to (1) summarize the results of our individual reviews related to incorrect billings for full vials of Herceptin and (2) determine the effectiveness of the Herceptin-specific edit that was implemented after our audit period.

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年度 2013
页码 1-21
总页数 21
原文格式 PDF
正文语种 eng
中图分类工业技术;
关键词
Medicare; Contractors; Claims; Herceptin(Trastuzumab); Drugs; Breast cancer; Beneficiaries; Billing; Audits; Outpatient services;

机译：医疗保险;承包商;索赔;赫赛汀（曲妥珠单抗）;药物;乳腺癌;受益人;计费;审计;门诊服务;

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Medicare Contractors Nationwide Overpaid Millions to Providers for Full Vials of Herceptin.

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