Medicare Compliance & Reimbursement

Providers of outpatient services should take note that their claims are under scrutiny by the HHS Office of Inspector General. In a recent audit report - part of a nationwide series of reviews - the OIG takes the measure of potentially excessive Medicare payments fiscal intermediary United Government Services made to institutional providers of outpatient services. What stood out in the review were claims for the drug Epogen - one dialysis facility incorrectly billed for 9.9 million units of the drug and was paid more than $80,000. Outpatient pharmacy charges also seemed excessive in some cases, the OIG says, with $1.3 million billed by one provider on only seven claims. In the past, such errors have been found out to be the result of clerical blunders, the watchdog agency notes in "Review of Potentially Excessive Medicare Payments United Government Services" (A-01-02-00516). The OIG adds that the apparent overpayments were isolated instances and didn't reflect widespread problems. Nevertheless, UGS is taking steps to address the issue. To see the report, go to http://oig.hhs.gov/oas/reports/region1/10200516.pdf.