The Office of Inspector General (OIG) issued a report on June 25 summarizing its study on replacement schedules for Medicare continuous positive airway pressure supplies. The study addresses concerns that while suppliers may be following the quantity guidelines for replacement supplies, patients may be receiving more supplies than medically necessary. To conduct its study, the OIG compared CPAP supply replacement schedules from Medicare to similar schedules created by Medicaid, fee-for-service Federal Employees Health Benefits plans, and schedules created by sleep clinicians and supply manufacturers.
The OIG found substantial variability across the different replacement schedules it reviewed. Medicaid replacement schedules varied from state to state with recommended replacements in some cases more frequent than Medicare and in some cases less frequent. Sleep clinicians and manufacturers typically reported replacement frequencies at rates less than Medicare’s replacement schedule.
Recommendations and Outcome
As a result of completing their study, the OIG recommended that the Centers for Medicare & Medicaid Services (CMS) review and revise their CPAP supply replacement schedule. CMS did not agree with the OIG’s recommendation. In the report executive summary, the OIG notes “CMS stated that failure to consider noncompliance or the potential impact of supplier fraud or abuse would bias the estimate of a clinically appropriate refill rate.” As a result, the despite the OIG’s recommendations, the CMS CPAP supply replacement schedule will remain consistent for the time being.