Review recent OIG activity, including a special fraud alert targeting contracts with telehealth companies.
The Office of Inspector General (OIG) has been busy lately. Review some of the latest OIG audits and reports to help ensure your organization is staying compliant.
Audit Shows CMS Slow to Collect $498M in Medicare Overpayments
Federal watchdogs say CMS still has not collected the nearly $500 million in Medicare overpayments identified in audits over a two-year period dating back to 2014.
The OIG at the Department of Health and Human Services did a follow-up review of 148 Medicare audits it conducted between October 1, 2014, and December 31, 2016, and could verify that CMS had collected only $120 million of the $498 million in overpayments.
Health System Dinged $3M by OIG for Incorrect Billing
In the recent audit, the OIG focused on seven groups of high-risk diagnosis codes, aiming to determine whether selected diagnosis codes submitted by Peoples Heath Network—a Medicare Advantage organization—for use in CMS’ risk adjustment program complied with federal requirements.
Feds List 7 Characteristics of a Fraudulent Telehealth Arrangement
Federal officials have issued a special fraud alert targeting contracts with telehealth companies and offered seven characteristics of an arrangement that could be illegal.
The notice, issued by the OIG, follows several recent investigations into companies claiming to offer what they define as telehealth services, but which often constitute illegal marketing schemes.
Medicare and its Members Paid Significantly More to Provider-Based Facilities
Medicare and its beneficiaries paid considerably more at provider-based facilities than they would have for the same services at freestanding facilities, according to the OIG.
The OIG's audit examined $3.95 billion paid for evaluation and management (E&M) services at provider-based facilities from 2010 to 2017 in eight states: California, Colorado, Florida, Louisiana, Michigan, Missouri New York, and Texas. Based on outpatient and Physician Fee Schedule claims for E&M services performed at provider-based facilities, researchers compared the data to what would have been paid at freestanding facilities.
Amanda Norris is the Director of Content for HealthLeaders.