OIG

Medical Groups & Billing Company Settle to Resolve Overbilling Scheme

Baltimore, Maryland B Medical billing company Engage Medical, Inc., its owner Sanjay Puri and three medical practices that were its clients have agreed to pay a total of $3,340,979 to resolve claims that Engage Medical overbilled for nuclear stress tests. Engage Medical and Sanjay Puri have agreed to pay $544,500; Advanced Cardiology Center and its owners Pankaj Lal, M.D., Mubashar Choudry, M.D. and Moshin Ijaz, M.D. agreed to pay $1,894,549.50; Reva Gill, M.D. and Kenilworth Internists, P.A. agreed to pay $242,204; and Sureshkumar Muttath, M.D. agreed to pay $659,726.

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OIG Posts 2012 Work Plan

The Office of Inspector General's ( OlG ) Work Plan sets forth various projects to be addressed during the fiscal year by the Office of Audit Services, Office of Evaluation and Inspections, Office of Investigations, and Office of Counsel to the Inspector General. The Work Plan includes projects planned in each of the Department's major entities: the Centers for Medicare & Medicaid Services; the public health agencies; the Administrations for Children & Families; and Administration on Aging.

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OIG Makes Available Federal Anti-kickback Statute Video and Podcast

The Anti-kickback Statute prohibits individuals or entities from knowingly and willfully offering, paying, soliciting, or receiving anything of value to induce or reward the referral of Federal health care program business. This audio and video podcast highlights what the statute prohibits, the law’s criminal penalties, the programs the law covers, and the safe harbors to the law.

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Compliance Culture and Officer Should be Protected

There are new tools being provided by the Health and Human Services Office of Inspector General on compliance.  The office has been posting educational resources to its Compliance 101 Web page.  Some of the educational materials recently posted included A Toolkit for Health Care Boards.  This toolkit includes among other things, a list of six objectives for promoting quality of care and six for evaluating your compliance program.

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Medicare Overpayments for Part B Claims with G Modifiers

Office of Inspector General (OIG) announced they recently finished a study on all Part B claims billed with G modifiers that the providers expect to be denied as either not “reasonable and necessary” (GA and GZ modifiers) or because they are not covered by Medicare (GY and GX modifiers).  These modifiers are used when they are uncertain about whether a claim should be paid. 

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High Level E/M Codes are Coming Under Increased Scrutiny by the OIG

The May 8, 2012, Office of Inspector General's report, Coding Trends of Medicare Evaluation and Management Services, says payments for E/M services increased 5% more than the rate of increase for all Part B payments from 2001 to 2010 (48% vs. 43%). Through claims data analysis, the OIG has identified those physicians who consistently billed the higher-level E/M codes in 2010.
The report says:

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