OIG Reports $20.97B in Savings and Recoveries in 2009

In its Semiannual Report to Congress, the Office of Inspector General (OIG) announced Dec. 3 a reported savings and expected recoveries of $20.97 billion for 2009 as a result of audits, investigations, and evaluations the agency conducted this year.

Of that $20.97 billion, the OIG says $16.48 billion is savings based on implemented recommendations to put funds to better use; $492 million is from audit receivables; and $4 billion is from investigative receivables.

Evaluation and Management – CEMC

Among the OIG’s most touted accomplishments during the semiannual period between April 1 and Sept. 30 are several cases involving Medicare fraud, waste, or abuse.

The following are a few of the OIG’s highlighted accomplishments within the semiannual report:

E/M Services Included in Eye and Ocular Adnexa Global Surgery Fees

The OIG estimates that Medicare paid $97.6 million for evaluation and management (E/M) services that were included in eye global surgery fees but not provided during the global surgery periods in 2005. According to the OIG, the global surgery fees did not reflect the number of E/M services provided to beneficiaries because the Centers for Medicare & Medicaid Services (CMS) had not adjusted or recently adjusted the relative value units for most of the sampled surgeries. By adjusting the estimated number of E/M services within eye global surgery fees to reflect the number of E/M services actually provided, the OIG says CMS could have reduced payments by as much as $97.6 million.

Medicare Hospice Care Compliance

The OIG found that 82 percent of hospice claims for beneficiaries in nursing facilities (NF) did not meet at least one Medicare coverage requirement. Medicare paid approximately $1.8 billion for these claims. More specifically, 33 percent of claims did not meet election requirements, and 63 percent did not meet plan of care requirements. For 31 percent of claims, hospices provided fewer services than outlined in beneficiaries’ plans of care. For 4 percent of claims, the certifications were missing or did not meet one or more federal requirements.

Power Wheelchairs Supplier Acquisition Costs and Services

According to the OIG, Medicare and Medicare beneficiary expenses for power wheelchairs far exceeded supplier acquisition costs in 2007. In a report, the OIG recommends that CMS determine whether Medicare’s standard and complex rehabilitation power wheelchair fee schedule amounts should be adjusted by using information from the Competitive Bidding Program, seeking legislation to ensure that fee schedule amounts are reasonable and responsive to market changes, or using its inherent reasonableness authority.

More Red Flags

Other Medicare Part B areas of interest to the OIG this year include:

  • Separately billed laboratory tests provided to end-stage renal disease (ESRD) patients;
  • Incident-to services provided by unqualified nonphysician providers (NPPs);
  • High-dollar payments;
  • Place of service coding;
  • Ultrasound billing; and
  • Clinical Laboratory Fee Schedule variations.

Read the Semiannual Report to Congress for further details.


Latest posts by admin aapc (see all)

Leave a Reply

Your email address will not be published. Required fields are marked *