jurisdiction: US

text: b' DEPARTMENT OF HEALTH & HUMAN SERVICES Office of Inspector General\n\n Washington, D.C. 20201\n\n\n\n\nFebruary 10, 2011\n\nTO: Donald M. Berwick, M.D.\n Administrator\n Centers for Medicare & Medicaid Services\n\n\nFROM: /Daniel R. Levinson/\n Inspector General\n\n\nSUBJECT: Review of Medicare Claims for Home Blood-Glucose Test Strips and Lancets\xe2\x80\x94\n Durable Medical Equipment Medicare Administrative Contractor for\n Jurisdiction B (A-09-08-00044)\n\n\nAttached, for your information, is an advance copy of our final report on Medicare claims for\nhome blood-glucose test strips and lancets for the durable medical equipment Medicare\nadministrative contractor for Jurisdiction B. We will issue this report to National Government\nServices, Inc., within 5 business days.\n\nIf you have any questions or comments about this report, please do not hesitate to call me, or\nyour staff may contact George M. Reeb, Assistant Inspector General for the Centers for\nMedicare & Medicaid Audits, at (410) 786-7104 or through email at George.Reeb@oig.hhs.gov\nor Lori A. Ahlstrand, Regional Inspector General for Audit Services, Region IX, at\n(415) 437-8360 or through email at Lori.Ahlstrand@oig.hhs.gov. Please refer to report number\nA-09-08-00044.\n\n\nAttachment\n\x0c DEPARTMENT OF HEALTH & HUMAN SERVICES Office of Inspector General\n\n Office of Audit Services, Region IX\n 90 \xe2\x80\x93 7th Street, Suite 3-650\n San Francisco, CA 94103\n\n\n\nFebruary 17, 2011\n\nReport Number: A-09-08-00044\n\nMs. Sandra Miller\nPresident\nNational Government Services, Inc.\n8115 Knue Road\nIndianapolis, IN 46250-1936\n\nDear Ms. Miller:\n\nEnclosed is the U.S. Department of Health & Human Services (HHS), Office of Inspector\nGeneral (OIG), final report entitled Review of Medicare Claims for Home Blood-Glucose Test\nStrips and Lancets\xe2\x80\x94Durable Medical Equipment Medicare Administrative Contractor for\nJurisdiction B. We will forward a copy of this report to the HHS action official noted on the\nfollowing page for review and any action deemed necessary.\n\nThe HHS action official will make final determination as to actions taken on all matters reported.\nWe request that you respond to this official within 30 days from the date of this letter. Your\nresponse should present any comments or additional information that you believe may have a\nbearing on the final determination.\n\nSection 8L of the Inspector General Act, 5 U.S.C. App., requires that OIG post its publicly\navailable reports on the OIG Web site. Accordingly, this report will be posted at\nhttp://oig.hhs.gov.\n\nIf you have any questions or comments about this report, please do not hesitate to call me, or\ncontact Jessica Kim, Audit Manager, at (323) 261-7218, extension 702, or through email at\nYun.Kim@oig.hhs.gov. Please refer to report number A-09-08-00044 in all correspondence.\n\n Sincerely,\n\n\n\n /Lori A. Ahlstrand/\n Regional Inspector General\n for Audit Services\n\n\nEnclosure\n\x0cPage 2 \xe2\x80\x93 Ms. Sandra Miller\n\n\nDirect Reply to HHS Action Official:\n\nMs. Nanette Foster Reilly\nConsortium Administrator\nConsortium for Financial Management & Fee for Service Operations\nCenters for Medicare & Medicaid Services\n601 East 12th Street, Room 235\nKansas City, MO 64106\n\x0cDepartment of Health & Human Services\n OFFICE OF\n INSPECTOR GENERAL\n\n\n\nREVIEW OF MEDICARE CLAIMS FOR\n HOME BLOOD-GLUCOSE\n TEST STRIPS AND LANCETS\n\n DURABLE MEDICAL EQUIPMENT\n MEDICARE ADMINISTRATIVE\n CONTRACTOR FOR\n JURISDICTION B\n\n\n\n Daniel R. Levinson\n Inspector General\n\n February 2011\n A-09-08-00044\n\x0c Office of Inspector General\n http://oig.hhs.gov\n\n\n\nThe mission of the Office of Inspector General (OIG), as mandated by Public Law 95-452, as amended, is\nto protect the integrity of the Department of Health & Human Services (HHS) programs, as well as the\nhealth and welfare of beneficiaries served by those programs. This statutory mission is carried out\nthrough a nationwide network of audits, investigations, and inspections conducted by the following\noperating components:\n\nOffice of Audit Services\n\nThe Office of Audit Services (OAS) provides auditing services for HHS, either by conducting audits with\nits own audit resources or by overseeing audit work done by others. Audits examine the performance of\nHHS programs and/or its grantees and contractors in carrying out their respective responsibilities and are\nintended to provide independent assessments of HHS programs and operations. These assessments help\nreduce waste, abuse, and mismanagement and promote economy and efficiency throughout HHS.\n\nOffice of Evaluation and Inspections\nThe Office of Evaluation and Inspections (OEI) conducts national evaluations to provide HHS, Congress,\nand the public with timely, useful, and reliable information on significant issues. These evaluations focus\non preventing fraud, waste, or abuse and promoting economy, efficiency, and effectiveness of\ndepartmental programs. To promote impact, OEI reports also present practical recommendations for\nimproving program operations.\n\nOffice of Investigations\nThe Office of Investigations (OI) conducts criminal, civil, and administrative investigations of fraud and\nmisconduct related to HHS programs, operations, and beneficiaries. With investigators working in all 50\nStates and the District of Columbia, OI utilizes its resources by actively coordinating with the Department\nof Justice and other Federal, State, and local law enforcement authorities. The investigative efforts of OI\noften lead to criminal convictions, administrative sanctions, and/or civil monetary penalties.\n\nOffice of Counsel to the Inspector General\nThe Office of Counsel to the Inspector General (OCIG) provides general legal services to OIG, rendering\nadvice and opinions on HHS programs and operations and providing all legal support for OIG\xe2\x80\x99s internal\noperations. OCIG represents OIG in all civil and administrative fraud and abuse cases involving HHS\nprograms, including False Claims Act, program exclusion, and civil monetary penalty cases. In\nconnection with these cases, OCIG also negotiates and monitors corporate integrity agreements. OCIG\nrenders advisory opinions, issues compliance program guidance, publishes fraud alerts, and provides\nother guidance to the health care industry concerning the anti-kickback statute and other OIG enforcement\nauthorities.\n\x0c Notices\n\n\n THIS REPORT IS AVAILABLE TO THE PUBLIC\n at http://oig.hhs.gov\n\n Section 8L of the Inspector General Act, 5 U.S.C. App., requires\n that OIG post its publicly available reports on the OIG Web site.\n\nOFFICE OF AUDIT SERVICES FINDINGS AND OPINIONS\n\n The designation of financial or management practices as\n questionable, a recommendation for the disallowance of costs\n incurred or claimed, and any other conclusions and\n recommendations in this report represent the findings and\n opinions of OAS. Authorized officials of the HHS operating\n divisions will make final determination on these matters.\n\x0c EXECUTIVE SUMMARY\n\nBACKGROUND\n\nPursuant to sections 1832(a)(1), 1861(s)(6), and 1861(n) of the Social Security Act, Medicare\nPart B covers home blood-glucose test strip and lancet supplies (test strips and lancets) that\nphysicians prescribe for diabetics. The Centers for Medicare & Medicaid Services (CMS)\ncontracts with four durable medical equipment Medicare administrative contractors (DME\nMAC) to process and pay Medicare Part B claims for test strips and/or lancets. The amount\nallowed for payment is equal to the lesser of the Medicare fee schedule amount or the amount\ncharged by a DME supplier. Medicare pays the beneficiary or the supplier the amount allowed\nfor payment, less the beneficiary share (i.e., deductibles and coinsurance).\n\nThe quantity of test strips and lancets that Medicare covers depends on the beneficiary\xe2\x80\x99s usual\nmedical needs. Medicare utilization guidelines allow up to 100 test strips and 100 lancets every\nmonth for insulin-treated diabetics and every 3 months for non-insulin-treated diabetics. To be\nreimbursed for a claim for any quantity of test strips and/or lancets, the DME supplier is required\nto maintain (1) a physician order containing the items to be dispensed, the specific frequency of\ntesting, and the physician\xe2\x80\x99s signature with the date and (2) proof of delivery. The supplier may\nrefill an order only when the beneficiary has nearly exhausted the previous supply and\nspecifically requests the supplies to be dispensed.\n\nAdditional requirements apply for reimbursement of a claim for a quantity of test strips and/or\nlancets that exceeds the utilization guidelines (high utilization claim). Specifically, there must be\ndocumentation in the beneficiary\xe2\x80\x99s medical records supporting the specific reason for the\nadditional supplies and documentation in the physician\xe2\x80\x99s or supplier\xe2\x80\x99s records supporting the\nactual frequency of testing. Further, the physician must have seen the patient and evaluated the\npatient\xe2\x80\x99s diabetic control within 6 months before ordering the quantity of supplies in excess of\nthe guidelines.\n\nNational Government Services, Inc. (NGS), the DME MAC for Jurisdiction B, allowed for\npayment $297 million in Medicare Part B claims for test strips and/or lancets for calendar year\n(CY) 2007. We focused our review on high utilization claims. To identify these claims, we\nanalyzed the information submitted by DME suppliers on the claim forms. We did not verify the\naccuracy of the claim information. We estimated that NGS allowed for payment $92 million for\nthe claims that we identified as high utilization claims.\n\nOBJECTIVE\n\nOur objective was to determine whether high utilization claims for test strips and/or lancets that\nNGS allowed for payment were supported in accordance with Medicare documentation\nrequirements.\n\n\n\n\n i\n\x0cSUMMARY OF FINDINGS\n\nOf the 100 sampled claims for test strips and/or lancets, 17 claims were supported in accordance\nwith Medicare documentation requirements. However, the remaining 83 claims were not\nsupported because each claim had one or more deficiencies:\n\n \xe2\x80\xa2 The quantity of supplies that exceeded utilization guidelines was not supported with\n documentation indicating the specific reason for the additional supplies, the actual\n frequency of testing, or the treating physician\xe2\x80\x99s evaluation of the patient\xe2\x80\x99s diabetic\n control within 6 months before ordering the supplies (61 claims).\n\n \xe2\x80\xa2 There was no documentation supporting that refill requirements had been met\n (36 claims).\n\n \xe2\x80\xa2 Physician orders were missing or incomplete (24 claims).\n\n \xe2\x80\xa2 Proof-of-delivery records were missing (seven claims).\n\nFor CY 2007, based on our sample results, we estimated that NGS inappropriately allowed for\npayment approximately $56.2 million in claims for test strips and/or lancets that we identified as\nhigh utilization claims. Of this amount, we estimated that NGS inappropriately paid\napproximately $42.2 million to DME suppliers.\n\nNGS made improper payments to DME suppliers because NGS did not have controls to ensure\nthat claims for test strips and/or lancets complied with certain Medicare documentation\nrequirements. Specifically, NGS did not have system edits to identify, and review when\nnecessary, high utilization claims. In addition, NGS did not have system edits to identify claims\nwith overlapping service dates for the same beneficiary. This billing pattern caused NGS to\nallow payment for claims when beneficiaries had not nearly exhausted previously dispensed test\nstrips and/or lancets.\n\nNGS could have saved Medicare an estimated $42.2 million for CY 2007 if it had had controls to\nensure that claims for test strips and/or lancets complied with certain Medicare documentation\nrequirements.\n\nRECOMMENDATIONS\n\nTo help achieve potential savings for the Medicare program in future years, we recommend that\nNGS:\n\n \xe2\x80\xa2 implement system edits to identify high utilization claims for test strips and/or lancets\n and work with CMS to develop cost-effective ways of determining which claims should\n be further reviewed for compliance with Medicare documentation requirements;\n\n \xe2\x80\xa2 implement system edits to identify claims for test strips and/or lancets that have\n overlapping service dates for the same beneficiary; and\n\n\n\n ii\n\x0c \xe2\x80\xa2 enforce Medicare documentation requirements for claims for test strips and/or lancets by\n (1) identifying DME suppliers with a high volume of high utilization claims,\n (2) performing prepayment reviews of those suppliers, and (3) referring them to the\n Office of Inspector General or CMS for further review or investigation when necessary.\n\nAUDITEE COMMENTS\n\nIn its written comments on our draft report, NGS agreed with our recommendations and provided\ninformation on actions that it had taken or planned to take to address the recommendations.\nNGS\xe2\x80\x99s comments are included in their entirety as Appendix E.\n\n\n\n\n iii\n\x0c TABLE OF CONTENTS\n\n Page\n\nINTRODUCTION......................................................................................................................1\n\n BACKGROUND .............................................................................................................1\n Medicare Program ................................................................................................1\n Durable Medical Equipment ................................................................................1\n National and Local Coverage Determinations .....................................................1\n Home Blood-Glucose Test Strip and Lancet Supplies ........................................2\n National Government Services, Inc. ....................................................................3\n\n OBJECTIVE, SCOPE, AND METHODOLOGY ...........................................................3\n Objective ..............................................................................................................3\n Scope ....................................................................................................................3\n Methodology ........................................................................................................4\n\nFINDINGS AND RECOMMENDATIONS ............................................................................5\n\n UNSUPPORTED CLAIMS FOR TEST STRIPS AND/OR LANCETS ........................5\n Lack of Documentation for Quantities in Excess of Utilization Guidelines .......5\n Lack of Documentation To Support Refills of Supplies ......................................7\n Missing or Incomplete Physician Orders ............................................................7\n Missing Proof-of-Delivery Records .....................................................................8\n\n EFFECT OF UNALLOWABLE CLAIMS .....................................................................9\n\n LACK OF CONTROLS ..................................................................................................9\n\n RECOMMENDATIONS .................................................................................................9\n\n AUDITEE COMMENTS...............................................................................................10\n\nOTHER MATTERS ................................................................................................................10\n\n INCORRECT MODIFIER.............................................................................................10\n\n INCORRECT UNIQUE IDENTIFICATION NUMBER .............................................10\n\nAPPENDIXES\n\n A: FRAME SAMPLE DESIGN AND METHODOLOGY\n\n B: FRAME SAMPLE RESULTS AND ESTIMATES\n\n\n\n\n iv\n\x0cC: ERROR SAMPLE DESIGN AND METHODOLOGY\n\nD: ERROR SAMPLE RESULTS AND ESTIMATES\n\nE: AUDITEE COMMENTS\n\n\n\n\n v\n\x0c INTRODUCTION\n\nBACKGROUND\n\nMedicare Program\n\nThe Medicare program, established by Title XVIII of the Social Security Act (the Act) in 1965,\nprovides health insurance coverage to people aged 65 and over, people with disabilities, and\npeople with end-stage renal disease. The Centers for Medicare & Medicaid Services (CMS)\nadministers the Medicare program.\n\nDurable Medical Equipment\n\nPursuant to sections 1832(a)(1), 1861(s)(6), and 1861(n) of the Act, Medicare Part B covers\ndurable medical equipment, prosthetics, orthotics, and supplies (DMEPOS). DMEPOS includes\nitems such as wheelchairs, hospital beds, oxygen tents, and medical supplies. Section\n1862(a)(1)(A) of the Act requires that, to be paid by Medicare, a service or an item be reasonable\nand necessary for the diagnosis or treatment of illness or injury or to improve the functioning of\na malformed body member.\n\nAs a result of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003,\nCMS contracted with four durable medical equipment Medicare administrative contractors\n(DME MAC) to process and pay Medicare Part B claims for DMEPOS. Pursuant to the\nStatement of Work, the DME MACs\xe2\x80\x99 responsibilities included, but were not limited to,\n(1) receiving Medicare Part B claims from DME suppliers and beneficiaries within their\njurisdictions, (2) performing edits 1 on these claims to determine whether they were complete and\nreimbursable, (3) calculating Medicare payment amounts and remitting payments to the\nappropriate parties, and (4) educating DME suppliers on Medicare requirements and billing\nprocedures.\n\nThe Statement of Work was modified to require the DME MACs to perform medical reviews as\nof March 1, 2008. Medical reviews include the collection of information and review of medical\nrecords to ensure that Medicare pays only for services that meet all Medicare coverage, coding,\nand medical necessity requirements. The amount allowed for payment is equal to the lesser of\nthe Medicare fee schedule amount or the amount charged by a DME supplier. Medicare pays the\nbeneficiary or the supplier the amount allowed for payment, less the beneficiary share (i.e.,\ndeductibles and coinsurance).\n\nNational and Local Coverage Determinations\n\nNational Coverage Determinations (NCD) describe the circumstances for Medicare coverage\nnationwide for specific medical service procedures or devices, including DMEPOS, and\n\n\n1\n An edit is programming within the standard claims processing system that selects certain claims; evaluates or\ncompares information on the selected claims or other accessible sources; and, depending on the evaluation, takes\naction on the claims, such as paying them in full, paying them in part, or suspending them for manual review.\n\n\n 1\n\x0cgenerally outline the conditions under which a service or device is considered covered. MACs\nare required to follow NCDs.\n\nA Local Coverage Determination (LCD) is a decision by a Medicare contractor, such as a MAC\nor program safeguard contractor, whether to cover a particular item or service on a\ncontractorwide basis pursuant to section 1862(a)(1)(A) of the Act. Medicare contractors may\nestablish or adopt LCDs when there is no NCD or when they need to further define an NCD.\nLCDs must be consistent with all statutes; rulings; regulations; and national coverage, payment,\nand coding policies.\n\nHome Blood-Glucose Test Strip and Lancet Supplies\n\nPursuant to sections 1832(a)(1), 1861(s)(6), and 1861(n) of the Act, Medicare Part B covers\nhome blood-glucose test strip and lancet supplies (test strips and lancets) that physicians\nprescribe for diabetics, whether they are insulin-treated or non-insulin-treated. The patient, using\na disposable sterile lancet, draws a drop of blood, places it on a test strip, and inserts the strip\ninto a home blood-glucose monitor to obtain a reading of the blood-sugar level. DME suppliers\nprovide test strips and lancets to beneficiaries.\n\nThe NCD for home blood-glucose monitors specifies coverage of test strips and lancets for\npatients who meet certain conditions and use home blood-glucose monitors to better control their\nglucose levels by frequently checking those levels and appropriately contacting their attending\nphysicians for advice and treatment. 2 However, the NCD does not specify utilization guidelines\nand documentation requirements for test strips and lancets.\n\nTo establish utilization guidelines and documentation requirements for test strips and lancets,\nDME MACs either established or adopted LCDs, which state that the quantity of test strips and\nlancets that Medicare covers depends on the beneficiary\xe2\x80\x99s usual medical needs. The LCD for\neach DME MAC further states that Medicare covers up to 100 test strips and 100 lancets every\nmonth for insulin-treated diabetics and every 3 months for non-insulin-treated diabetics. 3\n\nTo be reimbursed for a claim for any quantity of test strips and/or lancets, the DME supplier is\nrequired to maintain (1) a physician order containing the items to be dispensed, the specific\nfrequency of testing, and the physician\xe2\x80\x99s signature with the date and (2) proof of delivery. The\nsupplier may refill an order only when the beneficiary has nearly exhausted the previous supply\nand specifically requests the supplies to be dispensed.\n\nAdditional requirements apply for reimbursement of a claim for a quantity of test strips and/or\nlancets that exceeds the utilization guidelines (high utilization claim). Specifically, there must be\ndocumentation in the beneficiary\xe2\x80\x99s medical records supporting the specific reason for the\nadditional supplies and documentation in the physician\xe2\x80\x99s or supplier\xe2\x80\x99s records supporting the\nactual frequency of testing. Further, the physician must have seen the patient and evaluated the\n\n2\n Medicare National Coverage Determinations Manual, Pub. No. 100-03, chapter 1, section 40.2, effective\nJune 19, 2006.\n3\n Medicare considers 50 test strips as 1 unit and 100 lancets as 1 unit.\n\n\n 2\n\x0cpatient\xe2\x80\x99s diabetic control within 6 months before ordering the quantity of supplies in excess of\nthe guidelines.\n\nNational Government Services, Inc.\n\nNational Government Services, Inc. (NGS), a wholly owned subsidiary of WellPoint, Inc., has\nbeen the DME MAC for Jurisdiction B since January 1, 2007. CMS awarded a DME MAC\ncontract for Jurisdiction B to AdminaStar Federal, Inc. (AdminaStar), on January 6, 2006. The\noperations of AdminaStar and a few other companies were combined to form NGS. NGS\xe2\x80\x99s main\noffice is located in Indianapolis, Indiana, through which it serves Medicare beneficiaries residing\nin Illinois, Indiana, Kentucky, Michigan, Minnesota, Ohio, and Wisconsin. 4\n\nNGS allowed for payment $297 million in Medicare Part B claims for test strips and/or lancets\nfor calendar year (CY) 2007.\n\nOBJECTIVE, SCOPE, AND METHODOLOGY\n\nObjective\n\nOur objective was to determine whether high utilization claims for test strips and/or lancets that\nNGS allowed for payment were supported in accordance with Medicare documentation\nrequirements.\n\nScope\n\nWe focused our review on high utilization claims for test strips and/or lancets for CY 2007. To\nidentify these claims, we analyzed the information submitted by DME suppliers on the Medicare\nclaim forms. We did not verify the accuracy of the claim information. 5 We estimated that NGS\nallowed for payment $92 million for the claims that we identified as high utilization claims. (See\nAppendixes A and B.)\n\nWe did not review the overall internal control structure of NGS. Rather, we limited our review\nof internal controls to those that were significant to the objective of our audit.\n\nWe performed our review from July 2008 to July 2010 and conducted fieldwork at NGS\xe2\x80\x99s office\nin Indianapolis, Indiana.\n\n\n\n\n4\n AdminaStar temporarily served as the DME MAC for Virginia and West Virginia because of delays in awarding\nthe DME MAC contract for Jurisdiction C. After this contract was awarded and implemented in June 2007, these\ntwo States became part of Jurisdiction C.\n\n5\n During our audit, we determined that some claims we had identified as high utilization claims were in fact within\nthe Medicare utilization guidelines based on our review of the beneficiaries\xe2\x80\x99 medical records and additional analysis\nof the claim information.\n\n\n 3\n\x0cMethodology\n\nTo accomplish our objective, we:\n\n \xe2\x80\xa2 reviewed applicable Federal laws, regulations, and guidance;\n\n \xe2\x80\xa2 reviewed the LCD adopted by NGS;\n\n \xe2\x80\xa2 reviewed the Statement of Work for NGS prepared by CMS for the administration\n of DMEPOS;\n\n \xe2\x80\xa2 reviewed NGS\xe2\x80\x99s policies and procedures for processing Medicare claims for test\n strips and/or lancets;\n\n \xe2\x80\xa2 interviewed NGS officials to obtain an understanding of its Medicare claim\n processing procedures for test strips and/or lancets;\n\n \xe2\x80\xa2 obtained from the CMS National Claims History (NCH) files NGS\xe2\x80\x99s Medicare\n Part B claims for test strips and/or lancets with service dates ending in CY 2007\n and removed any service line in which the amount allowed for payment was less\n than the lowest nationwide Medicare Part B fee schedule amount in CY 2007\n ($32.74 for test strips and $10.83 for lancets);\n\n \xe2\x80\xa2 created a sampling frame from the NCH data and randomly selected a sample of\n 500 Medicare beneficiaries to estimate the number of high utilization claims that\n NGS allowed for payment (Appendixes A and B);\n\n \xe2\x80\xa2 randomly selected a sample of 100 high utilization claims 6 to estimate the\n amounts that NGS allowed for payment and paid to suppliers for claims that were\n not supported in accordance with Medicare documentation requirements\n (Appendixes C and D);\n\n \xe2\x80\xa2 obtained medical records and other documentation from suppliers and physicians\n for the 100 sampled claims;\n\n \xe2\x80\xa2 reviewed medical records and other documentation to determine whether each of the\n 100 sampled claims was supported in accordance with Medicare documentation\n requirements; and\n\n \xe2\x80\xa2 shared the results of our review with NGS.\n\nWe conducted this performance audit in accordance with generally accepted government\nauditing standards. Those standards require that we plan and perform the audit to obtain\n\n6\n Of the 100 claims, 24 claims were within the Medicare utilization guidelines based on our review of the\nbeneficiaries\xe2\x80\x99 medical records and additional analysis of the claim information.\n\n\n 4\n\x0csufficient, appropriate evidence to provide a reasonable basis for our findings and conclusions\nbased on our audit objectives. We believe that the evidence obtained provides a reasonable basis\nfor our findings and conclusions based on our audit objective.\n\n FINDINGS AND RECOMMENDATIONS\n\nOf the 100 sampled claims for test strips and/or lancets, 17 claims were supported in accordance\nwith Medicare documentation requirements. However, the remaining 83 claims were not\nsupported because each claim had one or more deficiencies. For CY 2007, based on our sample\nresults, we estimated that NGS inappropriately allowed for payment approximately $56.2 million\nin claims for test strips and/or lancets that we identified as high utilization claims. Of this\namount, we estimated that NGS inappropriately paid approximately $42.2 million to DME\nsuppliers.\n\nThe table below summarizes the deficiencies noted and the number of claims that contained each\ntype of deficiency.\n\n Summary of Deficiencies in Sampled Claims\n\n No. of Claims With\n Type of Deficiency Deficiencies 7\n Lack of Documentation for Quantities in Excess of Utilization 61\n Guidelines\n Lack of Documentation To Support Refills of Supplies 36\n Missing or Incomplete Physician Orders 24\n Missing Proof-of-Delivery Records 7\n\nNGS made improper payments to DME suppliers because NGS did not have controls to ensure\nthat claims for test strips and/or lancets complied with certain Medicare documentation\nrequirements. Specifically, NGS did not have system edits to identify, and review when\nnecessary, high utilization claims. In addition, NGS did not have system edits to identify claims\nwith overlapping service dates for the same beneficiary. This billing pattern caused NGS to\nallow payment for claims when beneficiaries had not nearly exhausted previously dispensed test\nstrips and/or lancets.\n\nUNSUPPORTED CLAIMS FOR TEST STRIPS AND/OR LANCETS\n\nLack of Documentation for Quantities in Excess of Utilization Guidelines\n\nFor a quantity of test strips and lancets in excess of the utilization guidelines, LCD L11530\nrequires that the treating physician document in the medical records the specific reason for the\nadditional supplies.\n\n7\n The total exceeds 83 because 50 of the 83 claims contained more than 1 deficiency.\n\n\n\n 5\n\x0cLCD L11530 also requires that when a DME supplier refills a physician order for a quantity of\ntest strips and lancets in excess of the utilization guidelines, \xe2\x80\x9c[T]here must be documentation in\nthe physician\xe2\x80\x99s records (e.g., a specific narrative statement that adequately documents the\nfrequency at which the patient is actually testing or a copy of the beneficiary\xe2\x80\x99s log) or in the\nsupplier\xe2\x80\x99s records (e.g., a copy of the beneficiary\xe2\x80\x99s log) that the patient is actually testing at a\nfrequency that corroborates the quantity of supplies that have been dispensed.\xe2\x80\x9d\n\nFinally, LCD L11530 states that the treating physician must have evaluated the patient\xe2\x80\x99s diabetic\ncontrol within 6 months before ordering the quantity of test strips and lancets in excess of the\nguidelines.\n\nFor 61 of the 100 sampled claims, the beneficiary\xe2\x80\x99s medical records did not have the required\ndocumentation to support a quantity of supplies in excess of the guidelines.\n\nNo Documentation of Specific Reason for Additional Supplies\n\nFor 56 of the 61 claims, the beneficiary\xe2\x80\x99s medical records did not indicate a specific reason for\nthe additional supplies. For example, for one claim, a supplier provided a copy of a physician\norder, which was prepared by the supplier on a preprinted form and signed by the physician,\nindicating a testing frequency of six times a day for an insulin-treated patient. The utilization\nguidelines for an insulin-treated patient specify a quantity of supplies indicating a testing\nfrequency of approximately three times a day. The patient\xe2\x80\x99s medical records indicated that the\npatient was treated with insulin but did not indicate a specific reason for the additional supplies.\n\nNo Documentation of Actual Testing Frequency\n\nFor 30 of the 61 claims, neither the physician\xe2\x80\x99s nor the supplier\xe2\x80\x99s records contained\ndocumentation supporting that the beneficiary was actually testing at a \xe2\x80\x9cfrequency that\ncorroborates the quantity of supplies that have been dispensed.\xe2\x80\x9d For example, for one claim, a\nDME supplier dispensed 7 units of test strips for an insulin-treated patient, which would be the\nquantity for a testing frequency of approximately 12 times a day. This testing frequency\ncorresponded to the physician order. However, neither the physician nor the supplier maintained\nrecords documenting that the patient was actually testing 12 times a day, such as a specific\nnarrative statement from the physician or a copy of the beneficiary\xe2\x80\x99s log.\n\nNo Documentation of Treating Physician\xe2\x80\x99s Evaluation of Patient\xe2\x80\x99s Diabetic Control\n\nFor 2 of the 61 claims, the beneficiary\xe2\x80\x99s medical records did not indicate that the physician\nevaluated the patient\xe2\x80\x99s diabetic control within 6 months before ordering the quantity of supplies\nin excess of the utilization guidelines. For example, a DME supplier submitted a claim for test\nstrips dispensed on February 23, 2007, to a non-insulin-treated patient based on a physician order\nsigned April 11, 2006. The physician order indicated a testing frequency of four times a day,\nwhich was in excess of the guidelines. However, the patient\xe2\x80\x99s medical records showed that the\nphysician was a cardiologist who had performed heart-related procedures for the beneficiary in\nFebruary 2006 before the order date. The medical records did not indicate that the physician had\ntreated the patient for a diabetic condition or had evaluated the patient\xe2\x80\x99s diabetic control.\n\n\n\n 6\n\x0cLack of Documentation To Support Refills of Supplies\n\nThe Medicare Program Integrity Manual (the Manual), Pub. No. 100-08, chapter 4,\nsection 4.26.1, states that, when a DME supplier refills an original order, the supplier must\ncontact the beneficiary before dispensing the refill. Further, the Manual states: \xe2\x80\x9cFor subsequent\ndeliveries of refills, the supplier should deliver the DMEPOS product no sooner than\napproximately 5 days prior to the end of usage for the current product.\xe2\x80\x9d\n\nLCD L11530 states that the DME supplier may not dispense test strips and lancets until the\nbeneficiary has nearly exhausted the previously dispensed supplies. In addition, a beneficiary or\nthe beneficiary\xe2\x80\x99s caregiver must specifically request the refill of test strips and lancets before the\nsupplier dispenses supplies to the beneficiary.\n\nFor 36 of the 100 sampled claims, suppliers did not have documentation that refill requirements\nhad been met.\n\nPreviously Dispensed Supplies Not Nearly Exhausted\n\nFor 29 of the 36 claims, DME suppliers dispensed test strips and/or lancets when the\nbeneficiaries had not nearly exhausted the previously dispensed supplies. Of the 29 claims,\n12 claims had multiple suppliers that had dispensed test strips and/or lancets for the same\nbeneficiary with overlapping service dates. In one instance, two suppliers had billed Medicare\nfor claims with overlapping service dates for the same beneficiary. The beneficiary\xe2\x80\x99s physician\nhad ordered a testing frequency of three times a day for an insulin-treated patient. The supplier\nfor the selected sample claim dispensed four units of test strips and submitted a claim to NGS for\nservice dates covering the period February 6 through May 5, 2007. In addition, a supplier\ndispensed six units of test strips and submitted a claim to NGS for the same beneficiary covering\nthe period January 30 through April 29, 2007. NGS allowed payment for both of these claims.\n\nRefills Not Specifically Requested\n\nFor 10 of the 36 claims, the beneficiary or the beneficiary\xe2\x80\x99s caregiver had not specifically\nrequested the refill before the supplies were dispensed. For example, for one claim, a DME\nsupplier did not have documentation supporting the specific refill request from the beneficiary or\nthe beneficiary\xe2\x80\x99s caregiver before it dispensed two units of test strips on June 8, 2007. When we\nrequested the documentation, the supplier stated that it did not maintain documentation\nindicating that beneficiaries specifically requested refills.\n\nMissing or Incomplete Physician Orders\n\nSection 1833(e) of the Act requires that providers furnish DME MACs with necessary\ninformation to receive payment for services provided to Medicare beneficiaries. The Manual,\nchapter 5, section 5.2.1, requires that the DME supplier obtain an order from the treating\nphysician before dispensing supplies to a beneficiary. The Manual, chapter 5, sections 5.2.2 and\n5.2.3, provide that when a DME supplier dispenses items based on a verbal order, the supplier\nmust have a written order in its records before submitting a claim to the DME MAC.\n\n\n\n 7\n\x0cLCD L11530 states: \xe2\x80\x9cAn order for each item billed must be signed and dated by the physician\nwho is treating the patient\xe2\x80\x99s diabetes, kept on file by the supplier, and made available upon\nrequest.\xe2\x80\x9d Further, the LCD requires that the order for test strips and lancets include (1) the\nspecific frequency of testing, (2) the treating physician\xe2\x80\x99s signature, and (3) the date of the\ntreating physician\xe2\x80\x99s signature.\n\nFor 24 of the 100 sampled claims, suppliers submitted claims when physician orders were\nmissing or incomplete.\n\nMissing Physician Orders\n\nFor 13 of the 24 claims, the DME suppliers did not have written physician orders. For 11 of the\n13 claims, suppliers did not provide copies of the written orders. For example, when we\ncontacted a supplier to obtain a copy of the order for one of the claims, an official stated that the\nsupplier did not maintain copies of written orders after supplies had been dispensed. For the\nremaining two claims, the suppliers had documentation of verbal orders from the physicians but\ndid not have written orders. The physician records did not contain copies of written orders or\nreferences to them.\n\nIncomplete Physician Orders\n\nFor 11 of the 24 claims, the DME suppliers had physician orders without required elements,\nincluding the specific frequency of testing, the treating physician\xe2\x80\x99s signature, and the date of the\nphysician signature:\n\n \xe2\x80\xa2 For nine claims, copies of the physician orders did not indicate the specific frequency of\n testing. Instead, they indicated \xe2\x80\x9cas directed\xe2\x80\x9d and/or the quantity of supplies (e.g., \xe2\x80\x9c50 test\n strips\xe2\x80\x9d).\n\n \xe2\x80\xa2 For three claims, copies of the physician orders did not have the physicians\xe2\x80\x99 signatures.\n For example, for one claim, a supplier provided a copy of the physician order signed by a\n licensed practical nurse.\n\n \xe2\x80\xa2 For one claim, the copy of the physician order did not have the date of the physician\xe2\x80\x99s\n signature. The physician\xe2\x80\x99s records did not indicate that he had ordered the supplies.\n\nMissing Proof-of-Delivery Records\n\nPursuant to 42 CFR \xc2\xa7 424.57(c)(12), DME suppliers are required to maintain proof of delivery of\nDME supplies provided to Medicare beneficiaries. The Manual, chapter 4, section 4.26, requires\nthat DME suppliers maintain proof-of-delivery documentation in their files for 7 years.\n\nFor 7 of the 100 sampled claims, suppliers did not maintain proof of delivery. When we\nrequested delivery records, the suppliers did not provide proof of delivery or provided printouts\nfrom their computerized dispensing systems containing dispensing information that did not\ncorrespond to the sampled claims. For example, for one claim, a supplier did not provide any\n\n\n 8\n\x0cdocumentation. When we requested proof of delivery, the supplier informed us that it could not\nlocate the documentation.\n\nEFFECT OF UNALLOWABLE CLAIMS\n\nFor 83 of the items in our sample, claims for test strips and/or lancets that we identified as high\nutilization claims were not supported in accordance with Medicare documentation requirements.\nAs a result, NGS allowed $7,348 in Medicare Part B payments for unallowable claims. Of this\namount, NGS inappropriately paid $5,519 to suppliers.\n\nFor CY 2007, based on our sample results, we estimated that NGS inappropriately allowed for\npayment $56,221,550 in claims for test strips and/or lancets that we identified as high utilization\nclaims. Of this amount, we estimated that NGS inappropriately paid $42,227,372 to suppliers.\n\nLACK OF CONTROLS\n\nNGS made improper payments to DME suppliers because NGS did not have controls to ensure\nthat claims for test strips and/or lancets complied with certain Medicare documentation\nrequirements. Specifically, NGS did not have system edits to identify, and review when\nnecessary, high utilization claims. In addition, NGS did not have system edits to identify\nsuppliers\xe2\x80\x99 claims with overlapping service dates for the same beneficiary. This billing pattern\ncaused NGS to allow payment for claims when beneficiaries had not nearly exhausted previously\ndispensed test strips and/or lancets.\n\nNGS could have saved Medicare an estimated $42,227,372 for CY 2007 if it had had controls to\nensure that claims for test strips and/or lancets complied with certain Medicare documentation\nrequirements.\n\nRECOMMENDATIONS\n\nTo help achieve potential savings for the Medicare program in future years, we recommend that\nNGS:\n\n \xe2\x80\xa2 implement system edits to identify high utilization claims for test strips and/or lancets\n and work with CMS to develop cost-effective ways of determining which claims should\n be further reviewed for compliance with Medicare documentation requirements;\n\n \xe2\x80\xa2 implement system edits to identify claims for test strips and/or lancets that have\n overlapping service dates for the same beneficiary; and\n\n \xe2\x80\xa2 enforce Medicare documentation requirements for claims for test strips and/or lancets by\n (1) identifying DME suppliers with a high volume of high utilization claims,\n (2) performing prepayment reviews of those suppliers, and (3) referring them to the\n Office of Inspector General or CMS for further review or investigation when necessary.\n\n\n\n\n 9\n\x0cAUDITEE COMMENTS\n\nIn its written comments on our draft report, NGS agreed with our recommendations and provided\ninformation on actions that it had taken or planned to take to address the recommendations.\n\nRegarding the first recommendation, NGS stated that it had implemented a service-specific edit\nafter a probe review in May 2008 found a high error rate for glucose monitor supplies.\nRegarding the second recommendation, NGS stated that it is developing an edit to address the\nproblem of overlapping service dates on claims for individual beneficiaries. Regarding the third\nrecommendation, NGS described multiple efforts to enforce Medicare documentation\nrequirements, including identifying DME suppliers with a high volume of high utilization claims,\nconducting prepayment reviews for glucose monitor supplies, and referring suppliers to other\nMedicare contractors for further review. NGS\xe2\x80\x99s comments are included in their entirety as\nAppendix E.\n\n OTHER MATTERS\n\nWe identified issues with DME suppliers\xe2\x80\x99 use of modifiers and unique physician identification\nnumbers for test strip and/or lancet claims.\n\nINCORRECT MODIFIER\n\nLCD L11530 requires that a Medicare claim for test strips and/or lancets include the KX\nmodifier for insulin-treated patients and the KS modifier for non-insulin-treated patients.\n\nFor 28 of the 100 sampled claims, DME suppliers submitted claims with incorrect modifiers.\nFor example, a claim from one supplier for test strips included the KS modifier rather than the\nKX modifier when the physician order indicated that the beneficiary was being treated with\ninsulin. The physician\xe2\x80\x99s medical records also supported that the beneficiary was being treated\nwith insulin.\n\nINCORRECT UNIQUE IDENTIFICATION NUMBER\n\nSection 1833(q)(1) of the Act requires that a Medicare claim include the unique identification\nnumber for the referring physician.\n\nFor 5 of the 100 sampled claims, DME suppliers submitted claims with incorrect unique\nidentification numbers for referring physicians. For example, a claim from one supplier for test\nstrips included an incorrect unique identification number for the referring (i.e., ordering)\nphysician. The supplier received its medication refill request form from the referring physician\xe2\x80\x99s\noffice before dispensing the supplies. However, the supplier incorrectly recorded the unique\nidentification number on the claim, which appeared to be a typographical error.\n\n\n\n\n 10\n\x0cAPPENDIXES\n\x0c Page 1 of 2\n\n\n APPENDIX A: FRAME SAMPLE DESIGN AND METHODOLOGY\n\nOBJECTIVE\n\nTo accomplish our audit objective, we reviewed a sample of claims (error sample) to determine\nwhether Medicare documentation requirements had been met and to estimate the effect of\nnoncompliance. The error sample included Medicare Part B claims for home blood-glucose test\nstrip and/or lancet supplies (test strips and/or lancets) that National Government Services, Inc.\n(NGS), allowed for payment with quantities that exceeded Medicare utilization guidelines based\non our analysis of claims (high utilization claims). To estimate the effect of noncompliance, it\nwas necessary to determine the total number of high utilization claims that NGS allowed for\npayment. However, because high utilization claims were not easily identifiable, we could not\ndetermine the total number of high utilization claims without significant time and effort.\nTherefore, the objective of reviewing this sample was to estimate the number of high utilization\nclaims that NGS allowed for payment (frame sample).\n\nPOPULATION\n\nThe population consisted of high utilization claims. The population was limited to the Part B\nclaims included in the Centers for Medicare & Medicaid Services (CMS) National Claims\nHistory file for calendar year (CY) 2007, updated as of December 2007.\n\nSAMPLING FRAME\n\nWe extracted Medicare Part B claims for test strips and/or lancets (Healthcare Common\nProcedure Coding System codes A4253 and A4259, respectively) with service dates ending in\nCY 2007. We removed from the claims any service line in which the amount allowed for\npayment was less than the lowest nationwide CY 2007 Medicare fee schedule amount ($32.74\nfor test strips and $10.83 for lancets). The result was a data file containing 2,920,352 claims for\ntest strips and/or lancets for 933,082 beneficiaries. This data file included claims with all\nquantities of test strips and/or lancets.\n\nTo identify high utilization claims for test strips and/or lancets, we determined that an in-depth\nanalysis of each of the 2,920,352 claims in the data file was needed. However, because it was\nnot practical to analyze all of these claims, we used a random sample to estimate the total\nnumber of and the amount allowed for payment for high utilization claims. The sampling frame\ncontained the 933,082 beneficiaries for whom the 2,920,352 test strip and/or lancet claims had\nbeen submitted to NGS.\n\nTo identify high utilization claims for the frame sample, we analyzed the information submitted\nby durable medical equipment (DME) suppliers on the claim form. We did not verify the\naccuracy of the information. However, during our audit, we determined that some claims we had\nidentified as high utilization claims were in fact within the Medicare utilization guidelines based\non our review of the beneficiaries\xe2\x80\x99 medical records and additional analysis of the claim\ninformation. Because it was not practical to obtain and review the medical records for all\nbeneficiaries with test strip and/or lancet claims, we considered a claim to be a high utilization\n\x0c Page 2 of 2\n\n\nclaim based solely on the claim information submitted by the DME supplier. Further, we did not\nperform additional analysis of all claims. As a result, the sampling frame of high utilization\nclaims contained claims in which the quantity of test strips and/or lancets was within the\nutilization guidelines.\n\nSAMPLE DESIGN\n\nWe used a simple random sample.\n\nSAMPLE UNIT\n\nThe sample unit was a beneficiary with one or more claims for test strips and/or lancets that NGS\nallowed for payment.\n\nSAMPLE SIZE\n\nThe sample size was 500 beneficiaries.\n\nSOURCE OF RANDOM NUMBERS\n\nWe used the Office of Inspector General, Office of Audit Services (OAS), statistical software to\ngenerate a set of random numbers.\n\nMETHOD OF SELECTING SAMPLE UNITS\n\nTo select the sample units, we consecutively numbered the sample units in the frame from 1 to\n933,082. After generating 500 random numbers, we selected the corresponding frame items. No\nframe sample unit was replaced.\n\nCHARACTERISTICS TO BE MEASURED\n\nFor each sample unit, we obtained all the beneficiary\xe2\x80\x99s claims for test strips and/or lancets and\nanalyzed the claim information submitted by DME suppliers to determine the number of high\nutilization claims.\n\nESTIMATION METHODOLOGY\n\nWe used the OAS statistical software to estimate the total number of high utilization claims that\nNGS allowed for payment, as well as the amount allowed for payment.\n\x0c APPENDIX B: FRAME SAMPLE RESULTS AND ESTIMATES\n\n\n Sample Results for Estimate of Total Number of Claims\n\n No. of\nBeneficiaries\n With Test No. of Claims\nStrip/Lancet for No. of Sampled\n Claims in Beneficiaries No. of No. of Claims for Beneficiaries That No. of High\n Sampling in Sampling Beneficiaries Sampled Had High Utilization Utilization Claims for\n Frame Frame in Sample Beneficiaries Claims Sampled Beneficiaries\n\n 933,082 2,920,352 500 1,684 163 412\n\n\n Sample Results for Estimate of Amount Allowed for Payment\n\n No. of\n Beneficiaries\n With Test Amount Allowed Amount No. of Sampled Amount Allowed\n Strip/Lancet for Payment by No. of Allowed for Beneficiaries That for High Utilization\n Claims in NGS in Sampling Beneficiaries Payment in Had High Claims for Sampled\nSampling Frame Frame in Sample Sample Utilization Claims Beneficiaries\n\n 933,082 $295,517,387 500 $169,084 163 $49,486\n\n\n Estimates for High Utilization Claims\n (Limits Calculated for a 90-Percent Confidence Interval)\n\n\n Estimated\n Estimated Amount\n Total No. of Allowed for\n Claims Payment\n Point estimate 768,860 $92,348,413\n Lower limit 644,743 76,922,019\n Upper limit 892,977 107,774,807\n\x0c Page 1 of 2\n\n\n APPENDIX C: ERROR SAMPLE DESIGN AND METHODOLOGY\n\nPOPULATION\n\nThe population consisted of Medicare Part B high utilization claims for test strips and/or lancets\nthat NGS allowed for payment. The population was limited to the Part B claims included in\nCMS\xe2\x80\x99s National Claims History file for CY 2007, updated as of December 2007.\n\nSAMPLING FRAME\n\nThe number of sample units in the sampling frame was unknown and was estimated by the\nsample described in Appendixes A and B.\n\nSAMPLE DESIGN\n\nWe used a simple random sample.\n\nSAMPLE UNIT\n\nThe sample unit was a high utilization claim for test strips and/or lancets.\n\nSAMPLE SIZE\n\nThe sample size was 100 high utilization claims for test strips and/or lancets.\n\nSOURCE OF RANDOM NUMBERS\n\nWe used the OAS statistical software to generate the random numbers.\n\nMETHOD OF SELECTING SAMPLE UNITS\n\nTo select the sample units, we consecutively numbered the test strip and/or lancet claims in the\ndata file from 1 to 2,920,352. Using the random numbers in the order in which they were\ngenerated, we matched each random number to the corresponding test strip and/or lancet claim.\nWe analyzed the claim corresponding to the first randomly generated number to determine\nwhether the claim was within the Medicare utilization guidelines. If the claim exceeded the\nutilization guidelines, we included it in the sample as a high utilization claim. If the claim did\nnot exceed the guidelines, we replaced it with the claim corresponding to the next randomly\ngenerated number and analyzed the newly selected claim. We continued this process until we\nhad identified 100 high utilization claims. 1\n\n\n\n\n1\n Of the 100 claims, 24 claims were within the utilization guidelines based on our review of the beneficiaries\xe2\x80\x99\nmedical records and additional analysis of the claim information.\n\x0c Page 2 of 2\n\n\nESTIMATION METHODOLOGY\n\nBased on the results of this sample and the sample described in Appendixes A and B, we used\nthe OAS statistical software to estimate the (1) amount allowed for payment by NGS for claims\nthat we identified as high utilization claims and were not supported in accordance with Medicare\ndocumentation requirements and (2) amount that NGS paid to DME suppliers for claims that we\nidentified as high utilization claims and were not supported in accordance with Medicare\ndocumentation requirements.\n\x0c APPENDIX D: ERROR SAMPLE RESULTS AND ESTIMATES\n\n\n Sample Results for Amount That NGS Allowed for Payment\n\n No. of Value of\n Claims With Value of Unallowable\n Sample Size Deficiencies Sample Amount\n 100 83 $11,655 $7,348\n\n\n Sample Results for Amount That NGS Paid to DME Suppliers\n\n No. of Value of\n Claims With Value of Unallowable\n Sample Size Deficiencies Sample Amount\n 100 76 1 $8,730 $5,519\n\n\n\n Estimates of Unallowable Amounts\n (Limits Calculated for a 90-Percent Confidence Interval)\n\n Amount NGS Amount NGS\n Allowed for Paid to DME\n Payment Suppliers\n Point estimate $56,221,550 $42,227,372\n Lower limit 43,122,050 31,945,161\n Upper limit 69,321,049 52,509,583\n\n\n\n\n1\n Payments for 76 of the 83 claims with deficiencies were made to DME suppliers. The payments for two claims\nwere made to the Medicare beneficiaries. For the remaining five claims, the payments were made to neither\nsuppliers nor the beneficiaries because the beneficiaries were required to pay deductibles.\n\x0c Page 1 of 4\n\n\n APPENDIX E: AUDITEE COMMENTS \n\n\n\n\nf~National GoVernme""itt\n ...- ServIc.... \t Medicare\n NationAl V;1Wm""",! So-rY\'io:eo,. I",.\n 11115 Kn""ROiId\n Indianopoll!. )nd;,n;, 462!50-1936\n II eMS eoor",,-w Agm/\n\n\n Report Number: A-()9..()8-00044\n\n Lori A. Ahlstrand\n Regionallnspcctor General for Audi Services\n Office of Aud it Services, Region IX\n 90-7\'" Street. Suite 3--650\n San Francisco, CA 94103\n\n Dear Ms. Ahlstrand:\n\n National Government Services (NGS) appreciates the opportunity to review and comment on the\n above referenced draft audit report. Responses \\0 the recommendations made by the Qffice of\n Inspector General are included below.\n\n 1. \t Recommendation\n Implement system edits to identify high utilization daims for test strips and/or lancets and\n work with eMS to develop cost-effective ways of determining which claims should be\n fw:thCf reviewed for compliance with Medicare dOCUJncnt<>tion requirements.\n\n NGS Response:\n We agree with the DIG\'s recumrnendation. Glucose monitor suppUes, test strips and\n lancets, have been a focus of the National Govenunenl Services (NGS) Jurisdiction B DME\n MAC medical review (MR) activities since the MR function returned to the DME MAC in\n March 2008. The data analysis that we perform to establish our Medical Rev iew Strategy\n gives strong weight to the [act that glucose monitor supplies are high in terms of allowed\n charges (currently the second highest policy group in Jurisdiction B) and that they have\n been consistently at or nea.r the top in terms of aRT errors (currently second highest).\n They have been the highest priority item for our MR department as evidenced by the fact\n that, over the past two and 11 half years, they have represented the greatest volume of\n developed and reviewed claims.\n\n NGS\' initiated a widespread (i.e., service-specific) probe review of glucose monitor supplies\n in M.-.y 2008. The high crror rate found on that review resulted in OUI establishing a service\xc2\xad\n specific edit for glucose monitor supplies which has continued to the present. We have\n prioritized our widespread review activities by focusing on those claims that represented\n the most egregious overutilization.\n\n Our ability to thoroughly address the problem of overutilization of glucose monitor\n supplies is limited by the resourc~s that an available to us. Jurisdiction B receives\n\n\n CAIS/\n -",....,..\xc2\xb7_-1\n\x0c Page 2 of 4\n\n\n\n\n approximately 3.6 million claims per year for glucose moni tor supplie~. Based on our data\n analysis, approximately 20% of those represent claims for quantities of test strips and/or\n lancets that exceed the utilization guidelines in the Len. Based on our funding. thE! total\n number of claims on which we arc able to perform complex manual MR for.wl DMEPOS\n items is a small fraction of the test strip and lancet claims that represent suspected\n overutilization.\n\n2. \t Recommendation\n Implement system edits to identify claims for test strips and/or lancets that have\n overlapping service dates for the same beneficial)\'.\n\n NGS Response:\n We agree with the D IG\'s recommendation. Up to this time, OUT edits have focused on\n individuaJ claims that exceed the Utili7-<1tion guidelines defined in the Glucose Monitors\n Local Coverage Determination (LCD). However, we arc currently in the pr()(;.\'e;S of\n developing an edit that will address the problem of overlapping dates of services on claims\n for individual beneficiaries.\n\n in addition to implementation of system edits, our Provider Outreach and Education WOE)\n department ca:ently sent a letter to Medicare beneficiaries who received their supplies from\n thrL.oe or more suppliers. Beneficiaries with multiple supplierti are very likely to have claims\n wi th overlapping dates of service.\n\n3. \t Recommendation\n Enforce Medicare documentation Tequirements for claims for test strips and/or lancets by\n (1) identifying DME suppliers with a lUgh \\\'olume of high utili~tion claims, (2) performing\n prepayment reviews of those DME suppliers, and (3) referring them to the Office of\n Inspector General or CMS for further review or investigation when necessary.\n\n NGS Response:\n We agree with the O IG\'s recommendations. We have identified high volume suppliers,\n especially those that rep resented significan t owrutilization, <IS t<lrgets for supplier-specific\n reviews.\n\n Our reviews of claims for glucose monitor supplies, both widespread and supplicr-spe<ific,\n have been conducted on a prepayment basis to maximize efficiency and to keep Medicare\n {rom paying for items that arc not medically necessary and/or do not meet other\n documentation requirements.\n\n Juri~diction B MR also refers to other contractors when appropriate.\n \xe2\x80\xa2 \t We refer supplicrs 10 Ihe rsc if we identify suspected fraudulent behavior. The PSC\n determines when it is appropriate to refer a case to the Office of the Inspector\n General.\n\x0c Page 3 of 4\n\n\n\n\n \xe2\x80\xa2 \t We have referred one largt\' volume national supplier to the Na tional Supplier\n Clearinghouse for consideration of revocation of its supplier number because it has\n repeatedly not responded to our requests for documentation.\n\n \xe2\x80\xa2 \t We have recommended that the Recovery Audit Contractor (RAe) consid...r review\n of high volume problem suppliers. Since the RAe has more ability to expand their\n medical review resources and thus address a much higher volume of claims, its\n review would have more of an impact on suppliers and would more likely result in\n a change in their behavior.\n\n In addition to our MR activities, NGS is addressing the problem of overntilization through a\n number of other interventions. Our POE Department has conclUded webinars and has a\n web-based self-study course to educate all suppliers. Our POE department provides\n individualized education to suppliers who have been the subject of supplier-speci\xc2\xa3ic\n reviews. A letter from the Jurisdiction B med ical director to prescribing physicians is\n available on ou r web site to assist supplien; in educating physicians concerning Medicare\n policy.\n\n4. \t Other Matters -Incorred Modifier\n LCD L11530 requires that a Medicare claim for test strips andJor lancets include the KX\n modifier for insulin_treated patienl$ and the K$ modifier for non_in_~ulin_tT\'eated patients.\n For 29 of the 100 sampled claims, DME suppliers submitted claims with incorrect modifiers.\n\n NGS Response:\n We have identified similar errors in the reviews that we have conducted. We have included\n education on this issue with individual sup pliers as a follow-u p to supplier-specific\n reviews. He has included information about the correct use of modifiers in our general\n education on glucose monitors supplies.\n\n\n5. \t Other Mattel\'S- Incorrect Unique Identifkation N umber\n Section 1833(q) (1) of the Act requires thai a Medicare claim include the unique\n identification number for the refer ring physician. For 5 of the 100 sampled claims, DME\n suppliers submitted claims with incorrect unique identification numbers for referring\n physicians.\n\n NGS Response:\n Education concerning the importance of accuracy in reporting the National Provider\n Identifier (NPI) for referring physiciaru> is a routine part of our general Provider Education\n and Outreach activitiel.\n\x0c Page 4 of 4\n\n\n\n\nIn conclusion, the Jurisdiction B DME MAC is working to address all of the recommendations\noutlined in the DIG report - within the scope of our available resources. We will continue with\nthese efforts and look for additional interventions to help address the prubl~ with\novcrutilization of glucose test strips and lancets.\n\n\n\n\nDavid Barnett\nJurisdiction B DME MAC Project Manager\n\x0c'


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type: legislation

jurisdiction: EU

text:
 |
 52014PC0443
 Ettepanek: EUROOPA PARLAMENDI JA NÕUKOGU MÄÄRUS ühelt poolt Euroopa ühenduste ja nende liikmesriikide ning teiselt poolt Bosnia ja Hertsegoviina vahelise stabiliseerimis- ja assotsieerimislepingu ning ühelt poolt Euroopa Ühenduse ja teiselt poolt Bosnia ja Hertsegoviina vahelise kaubandust ja kaubandusküsimusi käsitleva vahelepingu teatava rakenduskorra kohta (kodifitseeritud) /* COM/2014/0443 final - 2014/0206 (COD) */
 SELETUSKIRI
 1. Kodanike Euroopa jaoks peab komisjon
 oluliseks Euroopa Liidu õigust lihtsustada ja selgemaks muuta, nii et see oleks
 kodanikele loetavam ja kättesaadavam; see annab kodanikele parema võimaluse neile
 antud õigusi kasutada.
 Seda eesmärki ei ole võimalik saavutada, kuni
 arvukad sätted, mida on korduvalt ja sageli oluliselt muudetud, asuvad laiali,
 osad esialgses õigusaktis ja osad muutvates õigusaktides. Nii tuleb kehtiva
 õiguse kindlakstegemiseks uurida ja võrrelda suurt hulka õigusakte.
 Muudetud õigusaktide kodifitseerimine on seega
 oluline õiguse selguse ja loetavuse saavutamiseks.
 2. 1. aprillil 1987. aastal
 otsustas[1]
 komisjon anda oma talitustele ülesande kodifitseerida kõik õigusaktid hiljemalt
 kümnenda muudatuse järel. Komisjon rõhutas, et see on minimaalne nõue ning et
 õigusnormide arusaadavuse ja selguse huvides tuleks talitustel püüda nende
 vastutusalas olevaid tekste kodifitseerida veel tihedamini.
 3. Seda kinnitati Edinburghi Euroopa
 Ülemkogu eesistuja järeldustega detsembris 1992[2], rõhutades kodifitseerimise
 tähtsust, mis annab õiguskindlust konkreetsel ajahetkel asjas kohaldamisele
 kuuluva õiguse osas.
 Kodifitseerides tuleb täpselt järgida tavapäraselt
 Liidu õigusaktide vastuvõtmiseks ettenähtud seadusandlikku menetlust.
 Kuna kodifitseeritavatesse õigusaktidesse
 ei või teha sisulisi muudatusi, otsustasid Euroopa Parlament, nõukogu ja
 komisjon 20. detsembri 1994. aasta institutsioonidevahelises
 kokkuleppes, et kodifitseeritavate õigusaktide kiiremaks vastuvõtmiseks võib
 kasutada kiirendatud menetlust.
 4. Käesoleva ettepaneku eesmärk on
 kodifitseerida nõukogu 16. juuni 2008. aasta määrus (EÜ)
 nr 594/2008,[3]
 ühelt poolt Euroopa ühenduste ja nende liikmesriikide ning teiselt poolt Bosnia
 ja Hertsegoviina vahelise stabiliseerimis- ja assotsieerimislepingu ning ühelt
 poolt Euroopa Ühenduse ja teiselt poolt Bosnia ja Hertsegoviina vahelise
 kaubandust ja kaubandusküsimusi käsitleva vahelepingu teatava rakenduskorra
 kohta. Uus määrus asendab sellesse inkorporeeritud õigusaktid[4]; käesolevas ettepanekus
 on säilitatud kodifitseeritud õigusaktide sisu ja nende kokkupanemisel on
 tehtud ainult kodifitseerimiseks vajalikud vormilised muudatused.
 5. Kodifitseerimise ettepanek on
 koostatud määruse (EÜ) nr 594/2008 ja selle muutmisaktide eelneva
 konsolideerimise alusel 22 ametlikes keeltes, mis on teostatud Euroopa
 Liidu Väljaannete Talituse poolt andmetöötluse abil. Juhul kui
 artiklitele on antud uued numbrid, siis vastavus vanade ja uute numbrite vahel
 on näidatud tabelis, mis on kodifitseeritud määruse II lisas.
 ê Parandus, ELT L
 233, 30.8.2008, lk 1 (kohandatud)
 2014/0206 (COD)
 Ettepanek:
 EUROOPA PARLAMENDI JA NÕUKOGU MÄÄRUS
 ühelt poolt Euroopa ühenduste ja nende
 liikmesriikide ning teiselt poolt Bosnia ja Hertsegoviina vahelise
 stabiliseerimis- ja assotsieerimislepingu ning ühelt poolt Euroopa Ühenduse ja
 teiselt poolt Bosnia ja Hertsegoviina vahelise kaubandust ja kaubandusküsimusi
 käsitleva vahelepingu teatava rakenduskorra kohta (kodifitseeritud)
 EUROOPA PARLAMENT JA EUROOPA LIIDU NÕUKOGU,
 võttes arvesse Euroopa Ö Liidu toimimise
 lepingut Õ, eriti selle artikli Ö 207
 lõiget 2 Õ,
 võttes arvesse Euroopa Komisjoni ettepanekut,
 olles edastanud seadusandliku akti eelnõu
 liikmesriikide parlamentidele,
 võttes arvesse Euroopa Majandus- ja
 Sotsiaalkomitee arvamust[5],
 toimides seadusandliku tavamenetluse kohaselt
 ning arvestades järgmist:
 ê
 (1) Nõukogu määrust (EÜ)
 nr 594/2008[6]
 on oluliselt muudetud[7].
 Selguse ja otstarbekuse huvides tuleks kõnealune määrus kodifitseerida.
 ê Parandus, ELT L
 233, 30.8.2008, lk 1 (kohandatud)
 (2) 16. juunil 2008
 kirjutati Luxembourgis alla stabiliseerimis- ja assotsieerimislepingule („SAL”)
 ühelt poolt Euroopa Ühenduste ja nende liikmesriikide ning teiselt poolt Bosnia
 ja Hertsegoviina vahel.
 (3) 16. juunil 2008
 sõlmis nõukogu ühelt poolt Euroopa Ühenduse ja teiselt poolt Bosnia ja
 Hertsegoviina vahelise kaubandust ja kaubandusküsimusi käsitleva vahelepingu[8] („vaheleping”), millega
 Ö nähti Õ ette SALi kaubandust
 ja kaubandusküsimusi käsitlevate sätete ennetähtaegne jõustumine. Vaheleping Ö jõustus 1. juulil
 2008 Õ.
 (4) On tarvis kehtestada
 vahelepingu teatavate sätete kohaldamise kord. Kuna nende lepingute kaubandust
 ja kaubandusküsimusi käsitlevad sätted on suures osas ühesugused, peaks
 käesoleva määrusega reguleerima ka SALi rakendamist pärast selle jõustumist.
 (5) SALis ja vahelepingus on
 sätestatud, et tariifikvootide piires võib teatavaid Bosniast ja
 Hertsegoviinast pärinevaid kalandustooteid importida Ö liitu Õ vähendatud
 tollimaksumääraga. Seetõttu on vaja kehtestada nende tariifikvootide haldamise
 kord.
 (6) Kui on vaja kehtestada
 kaubanduse kaitsemeetmeid, tuleb need vastu võtta vastavalt nõukogu
 määrusele (EÜ) nr 260/2009[9],
 nõukogu määrusele (EÜ) nr 1061/2009[10],
 nõukogu määrusele (EÜ) nr 1225/2009[11]
 ja vajaduse korral ka nõukogu määrusele (EÜ) nr 597/2009[12].
 (7) Kui liikmesriik esitab
 komisjonile teavet võimaliku pettuse või halduskoostööga mittetoimetulemise
 kohta, kohaldatakse asjakohast Ö liidu Õ õigusakti, eelkõige
 nõukogu määrust (EÜ) nr 515/97[13].
 (8) Käesoleva määruse asjakohaste
 sätete rakendamisel peaks komisjoni abistama Euroopa Parlamendi ja nõukogu
 määruse (EL) nr 952/2013[14]
 artikliga 285 moodustatud tolliseadustiku komitee.
 ê 37/2014 art 1
 ja lisa, punkt 17, (kohandatud)
 (9) Vahelepingu ning Ö SALi Õ kahepoolsete kaitseklauslite
 rakendamine Ö eeldab Õ ühetaolisi tingimusi
 kaitsemeetmete ja muude meetmete vastuvõtmiseks. Need meetmed tuleks vastu
 võtta kooskõlas Euroopa Parlamendi ja nõukogu määrusega (EL) nr 182/2011[15].
 (10) Nõuetekohaselt põhjendatud
 juhtudel, mis on seotud erandlike ja otsustava tähtsusega asjaoludega
 vahelepingu artikli 24 lõike 5 punkti b ja artikli 25
 lõike 4 ning seejärel Ö SALi Õ artikli 39
 lõike 5 punkti b ja artikli 40 lõike 4 tähenduses, ning kui
 tungiv kiireloomulisus seda nõuab, peaks komisjon võtma vastu viivitamata
 kohaldatavad rakendusaktid,
 ê Parandus, ELT L
 233, 30.8.2008, lk 1 (kohandatud)
 ON VASTU VÕTNUD KÄESOLEVA MÄÄRUSE:
 Artikkel 1
 Ö Reguleerimisese Õ
 Käesoleva määrusega kehtestatakse teatav kord ühelt
 poolt Euroopa ühenduste ja nende liikmesriikide ning teiselt poolt Bosnia ja
 Hertsegoviina vahelise stabiliseerimis- ja assotsieerimislepingu („SAL”) ning
 ühelt poolt Euroopa Ühenduse ja teiselt poolt Bosnia ja Hertsegoviina vahelise
 kaubandust ja kaubandusküsimusi käsitleva vahelepingu („vaheleping”) teatavate
 sätete üksikasjalike rakenduseeskirjade vastuvõtmiseks.
 ê 37/2014 art 1
 ja lisa punkt 17 lg 1
 Artikkel 2
 Soodustused
 kalale ja kalandustoodetele
 Komisjon võtab kooskõlas käesoleva määruse
 artikli 9 lõikes 3 osutatud kontrollimenetlusega vastu kala ja
 kalandustoodete tariifikvoote käsitlevad vahelepingu artikli 13 ning
 seejärel SALi artikli 28 rakendamise üksikasjalikud eeskirjad.
 ê Parandus, ELT L
 233, 30.8.2008, lk 1
 Artikkel 3
 Tollimaksude
 vähendamine
 1. Kui lõikest 2 ei tulene teisiti,
 ümardatakse soodustollimaksumäär allapoole kümnendkohani.
 2. Kui
 lõike 1 kohaldamisel on tollimaksu soodusmäära arvutamise tulemus üks
 järgmistest, võrdsustatakse soodusmäär täieliku tollimaksust vabastamisega:
 a) väärtuseline tollimaks on 1 %
 või vähem või
 b) koguseline tollimaks on 1 euro
 üksiksumma kohta või vähem.
 ê 37/2014 art 1
 ja lisa punkt 17 lg 2 (kohandatud)
 Artikkel 4
 Tehnilised
 kohandused
 Käesoleva määruse kohaselt vastuvõetud sätete
 muudatused ja tehnilised kohandused, mis on vajalikud tulenevalt kombineeritud
 nomenklatuurikoodide ja TARICi alamrubriikide muutmisest või mis tulenevad
 liidu ning Bosnia ja Hertsegoviina vahelistest uutest lepingutest,
 protokollidest, kirjade vahetamisest või muudest dokumentidest või nende
 muutmisest, võetakse vastu kooskõlas artikli 9 lõikes 3 osutatud
 kontrollimenetlusega.
 Artikkel 5
 Üldine
 kaitseklausel
 Kui liidul on vaja võtta vahelepingu
 artikli 24 ja seejärel SALi artikli 39 kohast meedet, siis võetakse
 see meede vastu kooskõlas käesoleva määruse artikli 9 lõikes 3
 osutatud kontrollimenetlusega, kui vahelepingu artiklis 24 ja seejärel ka
 SALi artiklis 39 ei ole sätestatud teisiti.
 Artikkel 6
 Puuduse
 korral kohaldatavad sanktsioonid
 Kui liidul on vaja võtta vahelepingu
 artikli 25 ja seejärel SALi artikli 40 kohast meedet, siis võetakse
 see meede vastu kooskõlas käesoleva määruse artikli 9 lõikes 3
 osutatud kontrollimenetlusega.
 ê Parandus, ELT L
 233, 30.8.2008, lk 1
 Artikkel 7
 Erakorralised
 ja otsustava tähtsusega asjaolud
 Kui tekivad erakorralised ja otsustava
 tähtsusega asjaolud vahelepingu artikli 24 lõike 5 punkti b ja
 artikli 25 lõike 4 ning seejärel SALi artikli 39 lõike 5
 punkti b ja artikli 40 lõike 4 tähenduses, võib komisjon
 viivitamata võtta vahelepingu artiklites 24 ja 25 ning seejärel SALi
 artiklites 39 ja 40 sätestatud meetmeid.
 Kui komisjon saab liikmesriigilt taotluse,
 võtab ta selle kohta vastu otsuse viie tööpäeva jooksul alates taotluse
 saamisest.
 ê 37/2014 art 1
 ja lisa punkt 17 lg 3 (kohandatud)
 Komisjon võtab sellised meetmed vastu
 kooskõlas Ö käesoleva
 määruse Õ artikli 9
 lõikes 3 osutatud kontrollimenetlusega või kiireloomulistel juhtudel
 kooskõlas Ö käesoleva
 määruse Õ artikli 9
 lõikega 4.
 ê Parandus, ELT L
 233, 30.8.2008, lk 1 (kohandatud)
 Artikkel 8
 Põllumajandus-
 ja kalandustoodete kaitseklausel
 1. Kui Ö liit Õ peab rakendama
 põllumajandus- ja kalandustoodete suhtes vahelepingu artiklis 24 ja
 seejärel SALi artiklis 39 ettenähtud kaitsemeetme, teeb komisjon,
 olenemata käesoleva määruse artiklites 5 ja 6 osutatud menetlusest,
 liikmesriigi taotlusel või enda algatusel otsuse vajalike meetmete kohta pärast
 seda, kui ta on vajaduse korral kasutanud vahelepingu artiklis 24 ja
 seejärel SALi artiklis 39 sätestatud korda.
 Kui komisjon
 saab liikmesriigilt taotluse, teeb ta selle kohta otsuse:
 a) kolme tööpäeva jooksul alates
 taotluse kättesaamisest, kui ei kohaldata vahelepingu artiklis 24 ja
 seejärel SALi artiklis 39 sätestatud korda; või
 b) kolme päeva jooksul pärast
 vahelepingu artikli 24 lõike 5 punktis a ja seejärel SALi artikli 39
 lõike 5 punktis a osutatud kolmekümnepäevase ajavahemiku lõppemist,
 kui kohaldatakse vahelepingu artiklis 24 ja seejärel SALi artiklis 39
 sätestatud korda.
 Komisjon teavitab nõukogu meetmetest, mida ta
 on otsustanud rakendada.
 ê 37/2014 art 1
 ja lisa punkt 17 lg 4
 2. Komisjon võtab sellised meetmed vastu
 kooskõlas artikli 9 lõikes 3 osutatud kontrollimenetlusega või kiireloomulistel
 juhtudel artikli 9 lõike 4 kohaselt.
 ê 37/2014 art 1 ja
 lisa punkt 17 lg 5 (kohandatud)
 Artikkel 9
 Komiteemenetlus
 1. Artiklite 2, 4 ja 11 kohaldamisel
 abistab komisjoni määruse (EL) nr 952/2013 artikli 285 alusel
 loodud tolliseadustiku komitee. Nimetatud komitee on komitee määruse (EL)
 nr 182/2011 tähenduses.
 2. Artiklite 5 Ö – Õ 8 kohaldamisel
 abistab komisjoni määruse (EÜ) nr 260/2009 artikli 4 lõike 1
 alusel loodud kaitsemeetmete komitee. Nimetatud komitee on komitee
 määruse (EL) nr 182/2011 tähenduses.
 3. Käesolevale lõikele viitamisel kohaldatakse
 määruse (EL) nr 182/2011 artiklit 5.
 4. Käesolevale lõikele viitamisel kohaldatakse
 määruse (EL) nr 182/2011 artiklit 8 koostoimes artikliga 5.
 ê Parandus, ELT L
 233, 30.8.2008, lk 1 (kohandatud)
 Artikkel 10
 Dumping
 ja subsiidiumid
 Juhul kui mingi tegevus annab Ö liidule Õ põhjuse kohaldada
 vahelepingu artikli 23 lõikes 2 ja seejärel SALi artikli 38
 lõikes 2 sätestatud meetmeid, otsustatakse dumpinguvastaste ja/või
 tasakaalustusmeetmete võtmine vastavalt määrusele (EÜ) nr 1225/2009 ja/või (EÜ)
 nr 597/2009.
 Artikkel 11
 Konkurents
 1. Juhul kui mingi tegevus annab Ö liidule Õ põhjuse kohaldada
 vahelepingu artiklis 36 ja seejärel SALi artiklis 71 sätestatud
 meetmeid, otsustab komisjon pärast juhtumi oma algatusel või liikmesriigi
 taotlusel uurimist, kas kõnealune tegevus sobib lepingutega kokku.
 Vahelepingu artikli 36 lõikes 10 ja
 seejärel SALi artikli 71 lõikes 10 sätestatud meetmeid võetakse abi
 andmise korral vastu määruses (EÜ) nr 597/2009 sätestatud menetluse
 kohaselt ja muudel juhtudel Ö ELi toimimise
 lepingu Õ artiklis Ö 207 Õ sätestatud menetluse
 kohaselt.
 2. Juhul kui mingi tegevus annab Bosniale ja
 Hertsegoviinale põhjust kohaldada Ö liidu Õ suhtes meetmeid
 vahelepingu artikli 36 ja seejärel SALi artikli 71 alusel, otsustab
 komisjon pärast juhtumi uurimist, kas kõnealune tegevus sobib kokku
 vahelepingus ja seejärel Ö SALis Õ sätestatud põhimõtetega.
 Vajaduse korral teeb Ö komisjon Õ asjakohased otsused Ö ELi toimimise
 lepingu Õ artiklite 101,
 102 ja 107 kohaldamisest tulenevate kriteeriumide alustel.
 Artikkel 12
 Pettus
 või halduskoostööst hoidumine
 Kui komisjon
 leiab liikmesriikide esitatud teabe alusel või omal algatusel, et vahelepingu
 artiklis 29 ning seejärel SALi artiklis 44 sätestatud tingimused on
 täidetud, siis komisjon viivitamata:
 a) teavitab nõukogu ja
 b) teatab ajutisele komiteele ja
 seejärel stabiliseerimis- ja assotsieerimiskomiteele oma järeldused koos
 faktidega ning alustab konsultatsioone ajutise komitee ja seejärel
 stabiliseerimis- ja assotsieerimiskomitee raames.
 Komisjon avaldab Euroopa Liidu Teatajas
 kõik vahelepingu artikli 29 lõikele 5 ja seejärel SALi
 artikli 44 lõikele 5 vastavad teatised.
 ê 37/2014 art 1
 ja lisa punkt 17 lg 6
 Komisjon võib kooskõlas käesoleva määruse
 artikli 9 lõikes 3 osutatud kontrollimenetlusega võtta vastu otsuse
 ajutiselt peatada toodete sooduskohtlemine vastavalt vahelepingu
 artikli 29 lõikele 4 ja seejärel SALi artikli 44 lõikele 4.
 ê Parandus, ELT L
 233, 30.8.2008, lk 1 (kohandatud)
 Artikkel 13
 Teavitamine
 Ajutise komitee ja seejärel stabiliseerimis-
 ja assotsieerimisnõukogu ning stabiliseerimis- ja assotsieerimiskomitee
 teavitamine, nagu on nõutud vahelepingus või SALis, kuulub Ö liidu Õ nimel tegutseva
 komisjoni vastutusalasse.
 ê
 Artikkel 14
 Kehtetuks
 tunnistamine
 Määrus (EÜ) nr 594/2008
 tunnistatakse kehtetuks.
 Viiteid kehtetuks tunnistatud määrusele käsitatakse
 viidetena käesolevale määrusele ning neid loetakse vastavalt II lisas
 esitatud vastavustabelile.
 ê Parandus, ELT L
 233, 30.8.2008, lk 1 (kohandatud)
 Artikkel 15
 Jõustumine
 Käesolev määrus jõustub Ö kahekümnendal
 päeval pärast Õ selle Ö avaldamist Õ Euroopa Liidu
 Teatajas.
 Käesolev määrus on tervikuna siduv ja
 vahetult kohaldatav kõikides liikmesriikides.
 Brüssel,
 Euroopa Parlamendi nimel Nõukogu
 nimel
 President eesistuja
 [1] KOM(87) 868 PV.
 [2] Vt järelduste 3 lisa A osa.
 [3] Õigusloomeprogrammi lülitatud 2014.
 [4] Vt käesoleva ettepaneku I lisa.
 [5] ELT C [...], [...], lk [...].
 [6] Nõukogu määrus (EÜ) nr 594/2008, 16. juuni 2008,
 ühelt poolt Euroopa ühenduste ja nende liikmesriikide ning teiselt poolt Bosnia
 ja Hertsegoviina vahelise stabiliseerimis- ja assotsieerimislepingu ning ühelt
 poolt Euroopa Ühenduse ja teiselt poolt Bosnia ja Hertsegoviina vahelise
 kaubandust ja kaubandusküsimusi käsitleva vahelepingu teatava rakenduskorra
 kohta (ELT L 169, 30.6.2008, lk 1).
 [7] Vt I Lisa.
 [8] ELT L 169, 30.6.2008, lk 1.
 [9] Nõukogu määrus (EÜ) nr 260/2009,
 26. veebruar 2009, impordi ühiste eeskirjade kohta (ELT L 84,
 31.3.2009, lk 1).
 [10] Nõukogu määrus (EÜ) nr 1061/2009, 19. oktoober
 2009, millega kehtestatakse ühised ekspordieeskirjad (ELT L 291,
 7.11.2009, lk 1).
 [11] Nõukogu määrus (EÜ) nr 1225/2009,
 30. november 2009, kaitse kohta dumpinguhinnaga impordi eest riikidest,
 mis ei ole Euroopa Ühenduse liikmed (ELT L 343, 22.12.2009,
 lk 51).
 [12] Nõukogu määrus (EÜ) nr 597/2009, 11. juuni 2009,
 kaitse kohta subsideeritud impordi eest riikidest, mis ei ole Euroopa Ühenduse
 liikmed (ELT L 188, 18.7.2009, lk 93).
 [13] Nõukogu 13. märtsi 1997. aasta määrus (EÜ)
 nr 515/97 liikmesriikide haldusasutuste vastastikusest abist ning
 haldusasutuste ja komisjoni vahelisest koostööst tolli- ja
 põllumajandusküsimusi käsitlevate õigusaktide nõutava kohaldamise tagamiseks
 (EÜT L 82, 22.3.1997, lk 1).
 [14] Euroopa Parlamendi ja nõukogu 9. oktoobri 2008. aasta,
 määrus (EÜ) nr 952/2013, millega kehtestatakse liidu tolliseadustik
 (ELT L 269, 10.10.2013, lk 1).
 [15] Euroopa Parlamendi ja nõukogu määrus (EL)
 nr 182/2011, 16. veebruar 2011, millega kehtestatakse eeskirjad
 ja üldpõhimõtted, mis käsitlevad liikmesriikide läbiviidava kontrolli
 mehhanisme, mida kohaldatakse komisjoni rakendamisvolituste teostamise suhtes
 (ELT L 55, 28.2.2011, lk 13).
 é
 I LISA
 Kehtetuks tunnistatud määrus koos muudatusega
 Nõukogu määrus (EÜ) nr 594/2008 (ELT L 169, 30.6.2008, lk 1) || ||
 || Euroopa Parlamendi ja nõukogu määrus (EL) nr 37/2014 (ELT L 18, 21.1.2014, lk 1) || Üksnes lisa punktis 17 viidatud osas
 _____________
 II LISA
 Vastavustabel
 Määrus (EÜ) nr 594/2008 || Käesolev määrus
 Artiklid 1 kuni 8 || Artiklid 1 kuni 8
 Artikkel 8a || Artikkel 9
 Artikkel 9 || Artikkel 10
 Artikkel 10 || Artikkel 11
 Artikkel 11 || Artikkel 12
 Artikkel 13 || Artikkel 13
 – || Artikkel 14
 Artikkel 14 || Artikkel 15
 – || I lisa
 – || II lisa
 _____________


text:
 Svarīgs juridisks paziņojums
 |
 52005PC0704
 Priekšlikums Padomes Lemumam ar ko Lietuvai atļauj piemērot atkāpi no 21. panta Padomes Sestajā direktīvā 77/388/EEK par to, kā saskaņojami dalībvalstu tiesību akti par apgrozījuma nodokļiem /* COM/2005/0704 galīgā redakcija */
 [pic] | EIROPAS KOPIENU KOMISIJA |Briselē, 10.1.2006COM(2005) 704 galīgā redakcijaPriekšlikumsPADOMES LĒMUMAMar ko Lietuvai atļauj piemērot atkāpi no 21. panta Padomes Sestajā direktīvā 77/388/EEK par to, kā saskaņojami dalībvalstu tiesību akti par apgrozījuma nodokļiem(iesniegusi Komisija)PASKAIDROJUMA RAKSTSPRIEKšLIKUMA KONTEKSTS |Priekšlikuma pamatojums un mērķi Atbilstīgi 27. panta 1. punktam Padomes Sestajā direktīvā 77/388/EEK (1977. gada 17. maijs) par to, kā saskaņojami dalībvalstu tiesību akti par apgrozījuma nodokļiem - Kopēja pievienotās vērtības nodokļu sistēma: vienota aprēķinu bāze, Padome ar vienprātīgu lēmumu pēc Komisijas priekšlikuma var atļaut dalībvalstīm piemērot īpašus pasākumus, kas pieļauj atkāpi no minētās direktīvas, lai vienkāršotu nodokļu iekasēšanu un novērstu zināma veida nodokļu nemaksāšanas gadījumus vai izvairīšanos no nodokļa maksāšanas. Ar vēstuli, kas Komisijas Ģenerālsekretariātā tika reģistrēta 2005. gada 28. jūnijā, Lietuvas Republika lūdza atļauju tādu pasākumu ieviešanai, kuri pieļauj atkāpes no Direktīvas 77/388/EEK 21. panta. Saskaņā ar minētās direktīvas 27. panta 2. punktu Komisija ar 2005. gada 22. augustu datētā vēstulē informēja pārējās dalībvalstis par lūgumu, ko bija izteikusi Lietuva. Komisija 2005. gada 23. augustā rakstiski informēja Lietuvu, ka tās rīcībā ir visa informāciju, kuru tā uzskata par vajadzīgu, lai varētu izvērtēt jautājumu. |Vispārējais konteksts Principā 21. panta 1. punkts Direktīvā 77/388/EEK, tās 28. panta g) apakšpunktā izklāstītajā variantā, paredz, ka iekšējā sistēmā parasti nodokļu maksātājai personai, kas piegādā preces vai pakalpojumus, ir jāmaksā pievienotās vērtības nodoklis (PVN). Lietuvas valdība vēlētos piemērot pretēju iekasēšanas procedūru, kurā še turpmāk minētajās situācijās PVN ir jāmaksā nodokļu maksātājai personai, kurai piegādā preces vai sniedz pakalpojumus: - preču piegādes un pakalpojumi, ko īsteno nodokļu maksātāja persona, kam piemēro maksātnespējas procedūru vai pārstrukturēšanas procedūru tiesas iestāžu pārraudzībā; - kokmateriālu piegādes, ko veic nodokļu maksātāja persona; - melno metālu atgriezumu un lūžņu vai atlikumu piegādes un citu pārstrādājamu melno un krāsaino metālu materiālu piegādes, ko veic nodokļu maksātāja persona; - darbi, ko būvniecības nozarē apakšuzņēmējs veic galvenajam uzņēmējam, citam apakšuzņēmējam vai sabiedrībai, kas īsteno pašas būvniecības darbus. Nodokļu maksātājai personai, kam piemēro maksātnespējas procedūru vai pārstrukturēšanas procedūru tiesas iestāžu pārraudzībā un kas veic preču piegādes un pakalpojumus, bieži vien nav ne iespējas, ne vēlēšanās atmaksāt kompetentajām iestādēm PVN, kas iepriekš iekasēts no klientiem. No otras puses, pircējs, kas parasti ir likumīgs uzņēmējs, neskatoties ne uz ko, var atskaitīt PVN, ko samaksājis. Lietuvas kokmateriālu nozarē risks, ka nodokļi netiek samaksāti vai attiecīgās personas izvairās no nodokļu maksāšanas, ir augsts. Nozarē ir daudz uzņēmēju, bieži vien mazi tālākpārdevēji un starpnieki, kuri regulāri izbeidz savu darbību, nesamaksājot nodokli, kuru pirms tam iekasējuši no saviem klientiem. Lietuvas valdība tāpēc uzskata, ka ir svarīgi, lai atkāpe būtu piemērojama visiem posmiem, kas saistīti ar kokmateriālu piegādēm starp nodokļu maksātājām personām. Līdzīga ir situācija atkritumu apsaimniekošanas nozarē, kur uzņēmēji, kas veic savākšanu, šķirošanu un apstrādi bieži vien nav identificējami. Tādas pašas problēmas ir arī būvniecības nozarē, jo īpaši tad, kad būvdarbus veic apakšuzņēmēji, kas bieži nesamaksā nodokli. Pieprasītā atkāpe principā tiks piešķirta līdz 2009. gada 31. decembrim. Tomēr vajadzētu ņemt vērā, ka 2005. gada 16. martā Komisija iesniedza priekšlikumu direktīvai, kas groza Direktīvu 77/388/EEK attiecībā uz atsevišķiem pasākumiem, kas paredzēti tam, lai vienkāršotu PVN iekasēšanu un cīnītos pret nodokļu nemaksāšanu un izvairīšanos no nodokļu nemaksāšanas, un atceļ dažus lēmumus par atkāpēm (saskaņā ar 27. pantu piešķirto atkāpju racionalizēšana). Šis priekšlikums jo īpaši paredz, ka atsevišķos gadījumos var piemērot pretēju iekasēšanas mehānismu. Attiecībā uz šī lēmuma pasākumiem, uz ko attiecas atkāpes, kuras paredzētas racionalizācijas procesā, atļauja vairs nebūs spēkā no jaunās direktīvas spēkā stāšanās dienas. |Priekšlikuma darbības jomā spēkā esošie noteikumi Līdzīgas atkāpes attiecībā uz Direktīvas 77/388/EEK 21. pantu piešķirtas citām dalībvalstīm. |Atbilstība citām Eiropas Savienības politikām un mērķiem Nav piemērojama. |APSPRIEšANāS AR IEINTERESēTAJāM PERSONāM UN IETEKMES IZVēRTēJUMS |Apspriešanās ar ieinteresētajām personām |Nav piemērojamas. |Speciālu zināšanu vākšana un izmantošana |Ārēju speciālistu zināšanas nebija vajadzīgas. |Ietekmes izvērtējums Lēmuma priekšlikuma mērķis ir vienkāršot nodokļu iekasēšanas procedūru un apkarot nodokļu nemaksāšanu un izvairīšanos no nodokļu maksāšanas, un tāpēc tam var būt pozitīva ietekme uz ekonomiku. Jebkurā gadījumā ietekme nebūs būtiska, ko atkāpes darbības joma nav plaša. |PRIEKšLIKUMA JURIDISKIE ELEMENTI |Ierosināto pasākumu kopsavilkums Lietuvai piešķirta atļauja piemērot pasākumus, kas atkāpjas no 21. panta Direktīvā 77/388/EEK, attiecībā uz pretēja iekasēšanas mehānisma izmantojumu gadījumos, kad tiesas iestāžu pārraudzībā īsteno maksātnespējas procedūras, pārstrukturēšanu, kokmateriālu piegāžu, atsevišķu veidu atlikumu piegāžu un atsevišķu veidu būvdarbu gadījumos. |Juridiskais pamats Padomes Sestā direktīva 77/388/EEK (1977. gada 17. maijs) par to, kā saskaņojami dalībvalstu tiesību akti par apgrozījuma nodokļiem - Kopēja pievienotās vērtības nodokļu sistēma: vienota aprēķinu bāze, 27. panta 1. punkts. |Subsidiaritātes princips Priekšlikums ir ekskluzīvā Kopienas kompetencē. Subsidiaritātes princips tāpēc nav piemērojams. |Proporcionalitātes princips Priekšlikums ir saskaņā ar proporcionalitātes principu šādu iemeslu dēļ. |Lēmums attiecas uz atļauju, kas dalībvalstij piešķirta atbilstīgi tās lūgumam, un tas nekādi nav saistīts ar kādām saistībām. |Ņemot vērā atkāpes ierobežoto darbības jomu īpašais pasākums ir samērā ar vēlamo mērķi. |Instrumentu izvēle |Ierosinātie instrumenti: citi. |Citi līdzekļi nebūtu piemēroti šādu iemeslu dēļ. Saskaņā ar 27. pantu Padomes Sestajā direktīvā 77/388/EEK par to, kā saskaņojami dalībvalstu tiesību akti par apgrozījuma nodokļiem, vienīgi Padomes lēmums ir pieļaujams. |IETEKME UZ BUDžETU |Priekšlikumam nav ietekmes uz Kopienas budžetu. |PAPILDU INFORMāCIJA |Noteikums par pārskatīšanu/labošanu/termiņu |Priekšlikumā ir noteikums par termiņu. |1. PriekšlikumsPADOMES LĒMUMAMar ko Lietuvai atļauj piemērot atkāpi no 21. panta Padomes Sestajā direktīvā 77/388/EEK par to, kā saskaņojami dalībvalstu tiesību akti par apgrozījuma nodokļiem (Autentisks ir tikai teksts lietuviešu valodā)EIROPAS SAVIENĪBAS PADOME,ņemot vērā Eiropas Kopienas dibināšanas līgumu,ņemot vērā Padomes Sesto direktīvu 77/388/EEK (1977. gada 17. maijs) par to, kā saskaņojami dalībvalstu tiesību akti par apgrozījuma nodokļiem - Kopēja pievienotās vērtības nodokļu sistēma: vienota aprēķinu bāze[1] un jo īpaši tās 27. pantu,ņemot vērā Komisijas priekšlikumu,tā kā:2. Atbilstīgi 27. panta 1. punktam Direktīvā 77/388/EEK Padome ar vienprātīgu lēmumu pēc Komisijas priekšlikuma var atļaut dalībvalstij piemērot īpašus pasākumus, kas pieļauj atkāpi no minētās direktīvas, lai vienkāršotu nodokļu iekasēšanu un novērstu zināma veida nodokļu nemaksāšanas gadījumus vai izvairīšanos no nodokļa maksāšanas.3. Ar vēstuli, kas Komisijas Ģenerālsekretariātā tika reģistrēta 2005. gada 28. jūnijā, Lietuva lūdza atļauju tādu pasākumu ieviešanai, kuri pieļauj atkāpes no Direktīvas 77/388/EEK 21. panta.4. Saskaņā ar Direktīvas 77/388/EEK 27. panta 2. punktu Komisija ar 2005. gada 22. augustu datētā vēstulē informēja pārējās dalībvalstis par lūgumu, ko bija izteikusi Lietuva. Ar 2005. gada 23. augustu datētā vēstulē Komisija informēja Lietuvu, ka tās rīcībā ir visa informāciju, kuru tā uzskata par vajadzīgu, lai varētu izvērtēt jautājumu.5. Principā 21. panta 1. punkts Direktīvā 77/388/EEK, tās 28.g) pantā izklāstītajā variantā, paredz, ka iekšējā sistēmā parasti nodokļu maksātājai personai, kas piegādā preces vai pakalpojumus, ir jāmaksā pievienotās vērtības nodoklis (PVN).6. Atkāpe, ko lūgusi Lietuva, paredz, ka atsevišķās situācijās pakalpojumu saņēmējam ir jāmaksā PVN, kas maksājams attiecībā uz preču piegādēm vai pakalpojumiem, ko veikusi nodokļu maksātāja persona, uz ko attiecas tiesas iestāžu pārraudzībā īstenotas maksātnespējas procedūras vai pārstrukturēšanas procedūras, kokmateriālu piegāžu, melno un krāsaino metālu atlikumu piegāžu gadījumos, kā arī atsevišķu veidu būvdarbu gadījumos.7. Finansiālu grūtību dēļ nodokļu maksātājas personas, uz ko attiecas tiesas iestāžu pārraudzībā īstenotas maksātnespējas procedūras vai pārstrukturēšanas procedūras, bieži vien nevar samaksāt PVN, ko tās iekasē par savām preču piegādēm vai pakalpojumiem. Pakalpojumu saņēmējs tomēr var atskaitīt šo PVN pat tad, ja to piegādātājs nav samaksājis.8. Lietuvas kokmateriālu tirgus specifiskums un darbības, ko tajā veic, rada dažas problēmas. Tirgū faktiski dominē mazie uzņēmumi, bieži vien tālākpārdevēji un starpnieki, kurus nodokļu iestādēm ir grūti kontrolēt. No nodokļu samaksas tie bieži vien izvairās šādi: tie izraksta rēķinu par piegādēm un pēc tam izbeidz uzņēmējdarbību, nesamaksājot PVN un klientam atstājot derīgu rēķinu, pateicoties kuram tas var atskaitīt PVN.9. Līdzīgas problēmas, kas ir saistītas ar rēķinā ierakstīta PVN nemaksāšanu, ir melno un krāsaino metālu atlikumu apsaimniekošanas nozarē.10. Tāpat arī Lietuvas būvniecības nozarē ir līdzīgas problēmas attiecībā uz PVN, ko rēķinā ieraksta apakšuzņēmēji, kas pēc tam nav identificējami.11. Atļaujot nodokļu iestādēm noteikt, ka saņēmējs ir persona, kurai iepriekš norādītajos gadījumos jāsamaksā PVN, atkāpe novērš attiecīgās problēmas, neskarot nodokļu summu, kas ir jāsamaksā. Tā vienkāršo nodokļu iestāžu uzdevumu un uzlabo nodokļu iekasēšanu, kā arī novērš zināma veida nodokļu nemaksāšanas gadījumus vai izvairīšanos no nodokļa maksāšanas.12. Šis pasākums ir samērā ar vēlamo mērķi, jo tas nav piemērojams vispārēji, bet tikai attiecībā uz specifiskām darbībām un nozarēs, kurās ir reālas problēmas iekasēt nodokli, t.i., piedzīvoti nodokļa nemaksāšanas gadījumi vai izvairīšanās no nodokļa maksāšanas.13. Līdzīgas atkāpes tika piešķirtas citām dalībvalstīm un tās ir atzītas par iedarbīgām.14. Ir jānosaka, ka atļauja ir spēkā līdz 2009. gada 31. decembrim, tā, lai, ievērojot gūto pieredzi, varētu izvērtēt, vai atkāpe joprojām ir pamatota. Tomēr 2005. gada 16. martā Komisija ierosināja direktīvu, kas racionalizē dažas atkāpes atbilstīgi 27. pantam Direktīvā 77/388/EEK[2]. Tāpēc būtu jānosaka, ka šī lēmuma pasākumi, kurus paredz Komisijas priekšlikums, ir spēkā līdz jaunās direktīvas spēkā stāšanās dienai.15. Atkāpei nav negatīvas ietekmes uz Kopienas pašu resursiem, kas nāk no PVN,IR PIEŅĒMUSI ŠO LĒMUMU.1. pantsAtkāpjoties no 21. panta 1. punkta Padomes Sestajā direktīvā 77/388/EEK, minētās direktīvas 28. panta g) apakšpunkta variantā, un līdz 2009. gada 31. decembrim, Lietuva var noteikt, ka 2. pantā paredzēto preču vai pakalpojumu saņēmējs ir persona, kurai jāsamaksā PVN.2. pantsŠādos gadījumos var noteikt, ka preču piegāžu vai pakalpojumu saņēmējs ir persona, kurai jāsamaksā PVN:16. preču piegādes un pakalpojumi, ko veic nodokļu maksātāja persona, uz ko attiecas maksātnespējas procedūra vai pārstrukturēšanas procedūra tiesas iestāžu pārraudzībā;17. kokmateriālu piegādes;18. melno metālu atgriezumu un lūžņu vai atlikumu piegādes un citu pārstrādājamu melno un krāsaino metālu materiālu piegādes;19. pakalpojumi, kurus būvniecības nozarē apakšuzņēmējs veic galvenajam uzņēmējam, citam apakšuzņēmējam vai sabiedrībai, kas īsteno pašas būvniecības darbus.3. pantsLēmuma 1. pantā paredzētās atļaujas termiņš beidzas 2009. gada 31. decembrī. Tomēr lēmuma 2. panta 1., 3., un 4. punkts vairs nav spēkā dienā, kad stājas spēkā jaunā direktīva, kas racionalizē atkāpes, kas piešķirtas saskaņā ar 27. pantu Direktīvā 77/388/EEK un paredz specifisku režīmu PVN piemērošanai attiecīgajās nozarēs, ja vien minētais datums ir pirms 2009. gada 31. decembra.4. pantsŠis lēmums ir adresēts Lietuvas Republikai.Briselē,Padomes vārdā —priekšsēdētājs [1] OV L 145, 13.6.1977., 1. lpp. Direktīvā jaunākie grozījumi izdarīti ar Direktīvu 2004/66/EK (OV L 168, 1.5.2004., 35. lpp)[2] OV C 125, 24.5.2005., 12. lpp. KOM(2005)89


type: caselaw

text:
14.4.2014
 IT
 Gazzetta ufficiale dell’Unione europea
 C 112/35
 Ricorso proposto il 10 dicembre 2013 — Petco Animal Supplies Stores/UAMI — Gutiérrez Ariza (PETCO)
 (Causa T-664/13)
 2014/C 112/47
 Lingua in cui è stato redatto il ricorso: l'inglese
 Parti
 Ricorrente: Petco Animal Supplies Stores, Inc. (San Diego, Stati Uniti) (rappresentante: C. Aikens, Barrister)
 Convenuto: Ufficio per l'armonizzazione nel mercato interno (marchi, disegni e modelli).
 Controinteressato dinanzi alla commissione di ricorso: Domingo Gutiérrez Ariza (Malaga, Spagna)
 Conclusioni
 La ricorrente chiede che il Tribunale voglia:
 —
 annullare la decisione della quarta commissione di ricorso dell’Ufficio per l'armonizzazione nel mercato interno (marchi, disegni e modelli) del 7 ottobre 2013, procedimento R 347/2013-4;
 —
 condannare il convenuto alle spese.
 Motivi e principali argomenti
 Richiedente il marchio comunitario: la ricorrente
 Marchio comunitario di cui trattasi: il marchio denominativo «PETCO» per prodotti e servizi delle classi 3, 31 e 35 — domanda di marchio comunitario n. 10 114 081
 Titolare del marchio o del segno su cui si fonda l’opposizione: il controinteressato dinanzi alla commissione di ricorso
 Marchio e segno su cui si fonda l’opposizione: marchio comunitario n. 9 062 902 per il marchio figurativo di colore rosso e bianco contenente l’elemento denominativo «PETCO» per prodotti e servizi delle classi 31 e 35
 Decisione della divisione d'opposizione: accoglimento parziale dell’opposizione
 Decisione della commissione di ricorso: accoglimento parziale del ricorso
 Motivi dedotti: violazione dell’articolo 8, paragrafo 1, lettere a) e b) del regolamento sul marchio comunitario.