Noridian Healthcare Solutions, the Supplemental Medical Review Contractor (SMRC) for the Centers for Medicare & Medicaid Services (CMS), is conducting post-payment reviews of Medicare DME claims for intermittent urinary catheters with dates of service from Jan. 1, 2022, through Dec. 31, 2023.
In its announcement, Noridian referenced a February Washington Post story, “US Investigates Alleged Medicare Fraud Scheme Estimated at $2 Billion.” The story — quoting the health-care nonprofit National Association of Accountable Care Organizations (NAACOS) — said seven companies in Connecticut, Florida, Kentucky, New York and Texas used information from Medicare patients to bill Medicare for huge quantities of catheters that those patients did not order or receive.
NAACOS CEO Clif Gaus told the Post that the organization believes Medicare was fraudulently billed for $2 billion worth of catheters during 2022-2023. NAACOS added that in 2023, the seven companies billed Medicare for catheters on behalf of almost 406,000 patients in total.
As a comparison, in 2021, the year before the suspicious activity began, those companies billed Medicare on behalf of only 14 catheter patients, the Post story said.
The HCPCS codes in the Noridian review are A4351 (Intermittent urinary catheter, straight tip), A4352 (Intermittent urinary catheter coude tip), and A4353 (Intermittent urinary catheter, with insertion supplies).
“The SMRC will conduct medical record reviews in accordance with applicable waivers/flexibilities/statutory, regulatory, and sub-regulatory guidance,” Noridian said in its announcement.
The American Association for Homecare (AAHomecare) reported the review in its Dec. 4 bulletin.
“Of note is that the SMRC is the third contractor now auditing intermittent catheters,” the AAHomecare bulletin said. “Suppliers should carefully monitor the claims that are audited, as the same claim cannot be audited by more than one auditor (excluding UPIC and CERT). If a supplier determines a claim has previously been audited, they should notify the contractor, and it will be removed.”
