Nursing home suppliers promising free diapers managed to bill Medicare for $233 million for incontinence kits, including seldom-used syringes, lubricants and saline solutions, a federal investigator says.

Medicare's bill for patients' supplies jumped 265 percent between 1990 and 1993, although the number of patients fell 6 percent to 292,700, June Gibbs Brown, the inspector general of health and human services, said Tuesday.The payments were out of control, said Brown, with the worst problems in Florida.

Medicare doesn't pay for diapers or absorbent pads, but it does pay for catheters, external urinary collection pouches and accessories for patients with long-term incontinence problems.

Brown said some suppliers provided "free" diapers to nursing homes to get them to accept the incontinence kits, which the suppliers then billed Medicare for directly.

Brown said the items typically cost about $4, but the suppliers billed Medicare $20 apiece for up to three kits a day - $1,800 per month per patient.

Some suppliers tried to pass off diapers or absorbent pads as female urinary collection devices.

HHS auditors questioned $107 million of the $233 million payments, including $88 million spent on patients who did not have a catheter or other prosthetic device.

Investigators quoted one woman as saying that an aide at a nursing home caring for her mother "opened a little room to show me the supply of all that stuff, and she said they had so much they had to rent a storage place for it."

Another woman complained after discovering a supplier was billing Medicare $726 a month for kits for her mother, an incontinent Alzheimer's patient. Previously the nursing home had just used washable bed pads for her.

"I thought these charges were outrageous and asked that they be stopped," the woman is quoted by investigators as saying. "The nursing home administration could not understand my concern since `I didn't have to pay for it.' "

Brown said 55 percent of last year's payments were made by Florida Blue Shield, a private carrier that until recently handled these Medicare claims in the state. Nineteen suppliers accounted for a large chunk of the questionable billings, she said.