Medicare Compliance & Reimbursement

Agency combing through everything from injections to consulting agreements. In its semiannual report to Congress issued on Dec. 3, the Office of the Inspector General (OIG) reported that it recovered over $20 billion in fiscal year 2008 -- much of which reflects dollars recouped from physicians who billed improperly. The report lists several audit and investigation highlights that allowed the OIG to recover such huge amounts of money, and many of them may surprise you. For example: The OIG found that a whopping 63 percent of facet joint injection claims didnt meet the program requirements, totaling $96 million in Medicare overpayments to physicians. The top errors that the OIG found in this category -- documentation errors and billing add-on codes for bilateral injections -- are unfortunately fairly common among doctors that provide these types of injections, says Randall Karpf with East Billing in East Hartford, Conn. Rest assured that these are definitely areas that the OIG will be watching closely in the future. Place of Service Errors Abound The OIG report revealed that Medicare overpaid approximately $1.5 million to physicians in two states over a two-year period due to incorrect place of service coding. In its review, the OIG found that 85 percent of the sampled services were coded as having been performed in physicians offices although they were actually performed in ASCs or outpatient hospital departments. Consultant Nailed The report also lists several criminal and civil actions that the OIG took last year. For example, a healthcare consulting firm in New Jersey paid $2.8 million to resolve allegations that the consultants artificially inflated a hospitals cost-to-charge ratios, which triggered excessive outlier payments. Duplicate services: The report notes that a review of home health payments in five states determined that the government paid $1 million in error to Medicaid for supplies that Medicare also paid. The government appears inclined to continue its recovery efforts. OIG has achieved significant results in the fight against fraud, waste, and abuse in HHS programs, said Inspector General Daniel R. Levinson in the OIGs Dec. 3 press release. To read the report in its entirety, go online to the OIG Web site at http://www.oig.hhs.gov/publications/docs/semiannual/2008/semiannual_fall2008.pdf.