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Nationwide Audit of Medicare Payments for Intermittent Urinary Catheters

Announced on  | Last Modified on  | Project Number: A-09-22-03019
Status
Completed
Agency
Centers for Medicare and Medicaid Services

OBJECTIVE

Medicare covers reasonable and necessary durable medical equipment, prosthetics, and orthotics supplies (DMEPOS), such as intermittent urinary catheters (Social Security Act § 1861 (n) and (s)(8), and 1862(a)(1)(A)). For calendar year 2021, Medicare paid more than $308 million for intermittent urinary catheters. Prior reviews performed by OIG and CMS contractors have identified high improper payment rates for urological supplies (including intermittent urinary catheters) that did not meet Medicare requirements. Upon request, a supplier must provide documentation from the physician or treating practitioner indicating that the urological supplies were reasonable and necessary for the beneficiary's condition (42 CFR § 410.38(d)(3)). We will audit Medicare payments for intermittent urinary catheters to determine whether claims submitted by DMEPOS suppliers complied with Medicare requirements and guidance.

TIMELINE

REPORT PUBLISHED

Medicare Improperly Paid Suppliers for Intermittent Urinary Catheters (A-09-22-03019)

25-A-09-042.01 to CMS - Closed Implemented
Closed on 09/05/2025
We recommend that the Centers for Medicare & Medicaid Services instruct DME MACs to recover $11,399 in overpayments made to suppliers for the 15 sample items that did not meet Medicare requirements.

25-A-09-042.02 to CMS - Open Unimplemented
Update expected on 03/09/2026
We recommend that the Centers for Medicare & Medicaid Services instruct DME MACs to perform additional medical reviews of claims for intermittent urinary catheters and sterile catheter kits, which could have saved Medicare an estimated $35,079,833 for our audit period.

25-A-09-042.03 to CMS - Closed Implemented
Closed on 09/16/2025
We recommend that the Centers for Medicare & Medicaid Services instruct DME MACs to 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.

View in Recommendation Tracker
Work Plan Type
Office of Audit Services
HHS Agencies
Centers for Medicare and Medicaid Services
Issue Areas
Medical Supplies and Equipment
Target Groups
-
Financial Groups
Medicare B