In Audit
Feb 21st, 2018
Medical claims for off-the-shelf orthotic devices have nearly doubled in the past several years, which has attracted the attention of the Department of Health and Human Services (HSS) Office of Inspector General (OIG). As part of its ongoing Work Plan, the OIG intends to examine claims to be sure that Medicare beneficiaries are receiving a ...
In Audit
Feb 20th, 2018
A specimen validity test performed on the same day as a urine drug test for the same person should be a rare occurrence because specimen validity testing is included in the description of HCPCS Level II codes for urine drug tests. Billing both tests separately is like double-dipping. And yet, Medicare paid 4,180 clinical laboratories and physician offices ...
In Audit
Feb 4th, 2018
By congressional request, the Office of Inspector General (OIG) prompted a series of audits, which investigated group home abuse and neglect of developmentally disabled residents. The findings were horrifying. According to their website, they “found that these residents often experienced serious injuries and medical conditions that resulted in emergency room visits,” and that “99 percent ...
In Audit
Jan 31st, 2018
Instead of posting a yearly work plan for their invesigational efforts, The Office of Inspector General (OIG) now posts Active Work Plan items monthly. It’s because the U.S. Department of Health and Human Services (HHS) announced in June 2017 that it is updating the OIG Work Plan more frequently as an ongoing effort to enhance ...
In Audit
Jan 26th, 2018
The Centers for Medicare & Medicaid Services (CMS) measures the fee-for-service (FFS) improper payment rate through the Comprehensive Error Rate Testing (CERT) program. According to a 2017 CERT report, CMS had a 90.5 percent proper payment rate and a 9.5 percent improper payment rate for all claims submitted July 1, 2015, to June 30, 2016. ...