Medicare Improperly Paid Suppliers for Intermittent Urinary Catheters

We recommend that the Centers for Medicare & Medicaid Services instruct DME MACs to do the following: Recover $11,399 in overpayments made to suppliers for the 15 sample items that did not meet Medicare requirements.

We recommend that the Centers for Medicare & Medicaid Services instruct DME MACs to do the following: Provide additional education to suppliers on documenting eligibility for intermittent urinary curved-tip catheters and sterile catheter kits and on documenting refills of catheters and sterile catheter kits. For example, CMS could emphasize the following:

-Medical records that list only a diagnosis without adequate documentation of an enrollee's inability to use a straight-tip catheter are insufficient to support medical necessity for use of a curved-tip catheter.

-Notations of urinary tract infections in medical records are insufficient to support that an enrollee is eligible for sterile catheter kits, and there must be documentation supporting that the enrollee: (1) had two instances of urine cultures with greater than 10,000 colony-forming units of a urinary pathogen during a 12 month period before initiation of a sterile catheter kit and (2) had one or more qualifying concurrent conditions.

-There must be documentation supporting that a supplier contacted an enrollee before dispensing a refill of catheters or sterile catheter kits.