Do you bill for Herceptin? Is Palmetto your Medicare administrative contractor (MAC)? If so, you have been getting overpaid – and may have to give that money back to CMS.
 
According to a Feb. 26 audit report from HHS’ Office of Inspector General (OIG), payments to providers in Palmetto’s Jurisdiction 1 for full vials of Herceptin (trastuzumab), a breast cancer drug, from 2011 to 2012, were paid incorrectly 75% of the time. That yielded nearly $2 million in overpayments.
 
Of those that were correctly identified, providers refunded overpayments on less than 10% of the audited line items, totaling $383,000.
 
But for the claims that were wrongly paid, OIG says providers made one of the following mistakes: (1) listed unit counts for full multi-use vials, (2) didn’t provide supporting documentation, (3) billed for unallowable services, or (4) reported a combination of incorrect units and HCPCS code, the OIG says.
 
The agency urged Palmetto to recoup the $1.7 million in overpaid claims so those providers who bill Herceptin should be prepared to repay a chunk back to CMS in the coming months.