Noridian Healthcare Solutions, LLC (Noridian), as the Supplemental Medical Review Contractor (SMRC) for the Centers for Medicare and Medicaid (CMS), announced that they are conducting post-payment review of Medicare DME intermittent urinary catheter claims billed with dates of service from January 1, 2022, through December 31, 2023.
Why Catheters?
On February 9, 2024, the Washington Post published an article titled, “U.S. investigates alleged Medicare fraud scheme estimated at $2 billion,” which alerted readers of an investigation surrounding the utilization of intermittent catheters that resulted from beneficiary complaints suggesting potential fraud. As a result of the investigation, seven suppliers were identified in a scheme to bill claims for Medicare beneficiaries who either did not need the catheters or did not receive them.
In May 2024, Noridian Healthcare Solutions, LLC (Noridian) as the Supplemental Medical Review Contractor (SMRC), completed research on Healthcare Common Procedure Coding System (HCPCS) codes A4351(Intermittent urinary catheter, straight tip), A4352 (Intermittent urinary catheter, coude tip), and A4353 (Intermittent urinary catheter, with insertion supplies) and noted an increase in claim volume.
The SMRC is tasked to perform data analysis and conduct medical record review on claims billed with intermittent urinary catheter HCPCS codes A4351, A4352, and A4353 billed with dates of service January 1, 2022, through December 31, 2023.
Need Some Help?
The van Halem Group’s team of experts are here for you! If you receive an audit request from the SMRC we can help! Our clinicians can review your patient files and advise of any missing documentation and help assess your risk. If the audit findings reveal an overpayment is due, our appeals team can manage your claims through the appeals process. Contact us today to learn how we can help.