OIG Audits Find More Providers Overcharging Medicare

CMS acting administrator Charlene Frizzera wrote in response that CMS agrees with the audit. Since November, 2008, "CMS has been formally "testing a new control as part of a monthly Beneficiary Payment Validation procedure to identify duplicate payments," she said. Frizzera added that for April 2009, a total of 70 beneficiaries were identified as having "questionable enrollments in multiple plans."

Two dialysis centers were also targeted by separate OIG audits for overbilling for administration of Epogen, an expensive drug to treat anemia that is common in patients with kidney disease, over the course of a 30-month period starting Jan. 1, 2004.

Fresenius Medical Care, First State, in New Castle, DE and Fresenius Medical Care, Beckley, WV overbilled Medicare $7,187 and $25,886 respectively for Epogen injections.

The OIG's audit said the amounts of Epogen that were billed did not match the units ordered by attending physicians, as reflected in medical records of the two facilities.

In dialysis, Epogen is a significant amount of Medicare reimbursement. For example, at the First State facility, $5,916,116 was provided in Medicare services during this time period, and of that, $1,719,455 was for the administration of Epogen, the OIG audit said.

Similarly, at the Beckley facility, $4,881,172 in Medicare services was provided from Jan. 1, 2004 through June 30, 2006, and of that, $1,698,935 was for Epogen.

Altoona Regional Health System's two hospitals, Altoona and Bon Secours in Altoona, PA, misstated salaries, workers' hours, service costs and wage-related benefits for a total amount of $1,114,822 for the 2005 fiscal year that ended Sept. 30, 2005.

"The errors occurred because the Hospital did not sufficiently review and reconcile its reported wage data to supporting documentation to ensure that the data were accurate, supportable, and in compliance with Medicare requirements," the OIG audit said. The audit suggested that CMS require reconciliation procedures to ensure that future cost reports are accurate and in compliance with Medicare rules.

However, it is unclear from the audit whether the OIG suggested that Altoona would have to pay the money back.