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Medicare is paying - twice - for some treatments for patients

By Phillip Swarts

Tuesday - 6/25/2013, 6:16pm  ET

Some times seconds are good.  Ice cream.  Vacations.  But not necessarily medicines. 

A pair of reports from a federal watchdog finds that Medicare is paying millions for unneeded second helpings of vaccines and medical equipment for beneficiaries.

“An important aspect of cost control is to ensure that beneficiaries receive only the quantities sufficient to meet the needs of their clinical conditions,” said the report by the Health and Human Services Department Office of Inspector General.  “Providing more supplies than necessary may lead to wasteful spending.”

Between 2007 and 2011, Medicare paid roughly $7 million to give pneumonia vaccines to seniors twice.  The IG said 122,500 people unnecessarily received a second inoculation. 

"Some providers are providing repeat pneumococcal vaccinations to Medicare beneficiaries aged 65 years and older, and Medicare is paying for vaccinations more often than recommended," the IG said.  "The data suggest a need to educate certain providers about repeat vaccinations."

The amount is a small part of the 4.6 million people who received the vaccine, but the IG said it's still cause for concern.  In addition to the wasted millions, adverse reactions are possible for patients over 65.

"Vaccination is not without risk," the IG said, noting that there were more than a 1,000 bad reactions to vaccines, some of which required a visit to the emergency room.

But it should be an easy fix, the IG said.  Forty-three percent of patients receiving vaccination twice are being inoculated by the same medical provider.  Carefully reviewing the medical records of patients could allow healthcare providers to realize they've given that person the vaccine before, investigators said.

Investigators also found Medicare was sending more equipment than was needed to patients who use devices to assist in breathing

"In 2012, HHS’s Centers for Medicare & Medicaid Services found that beneficiaries receiving continuous positive airway pressure treatment for obstructive sleep apnea may have received more supplies (e.g., masks, tubing) than medically necessary," the IG said.

Investigators compared the federal Medicare to state Medicaid programs and found that the national program paid for replacement medical equipment more often than 39 percent of states and at the same rate of 51 percent of the states.

That means the government is unnecessarily paying to replace the equipment before it wears out, investigators said.

Many states are trying to change their programs to pay less frequently.  New York, for example, use to send beneficiaries three air filters every two months.  Now they send two filters every six months.

It’s an initiative the IG said the federal government should implement, suggesting that CMS consider revising how often they replace the airway equipment.  But Medicare officials disagreed.  A longer time between replacements would hurt patients that don’t follow a strict schedule of therapy, as well as leave all beneficiaries vulnerable to fraud on the part of medical equipment providers.

“We believe additional information on our specific population as well as that related to Medicare suppliers should be explored before any recommendations are provided,” a response from CMS said.

But the IG disagreed, saying its review provided enough information to warrant CMS to evaluate its policies.

Having an exact schedule for replacements can sometimes be difficult, investigators said, and some medical equipment manufacturers suggested just leaving it up to the individual patient to determine when their supplies needed replacing.

“Instead of specific frequency recommendations, each of the manufacturers commented that the frequency of replacement was variable and was based on individual use, method and frequency of cleaning, and the environment in which the…equipment was used,” the report said.