Actions Needed To Stop Excess Medicare Payments for Blood and Blood Products

HRD-78-172: Published: Feb 26, 1979. Publicly Released: Feb 26, 1979.

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An evaluation of the blood replacement practices at community and hospital blood banks was made to determine consistency with Medicare regulations. Medicare insurance for the aged and disabled covers health care services, including blood and blood products. It also reimburses hospitals for fees charged by blood banks for blood processing.

Medicare controls did not prevent unfair blood billing and replacement practices. Some hospitals charged nonreplacement fees to Medicare and to Medicare patients for blood supplied by community blood banks that charged only for processing. Hospitals often do not submit corrected bills to Medicare when blood banks release blood credits after the hospital has billed Medicare. When improper replacement practices of blood banks cease and blood banks are required to release all needed credits, the hospitals' failure to submit corrected bills will result in excess Medicare payments. Intermediaries responsible for program administration were generally unaware of the billing and replacement practices of blood banks and hospitals, or of the impact those practices have on Medicare payments.

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