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OIG accuses sleep study providers of false billing practices

The Office of the Inspector General (OIG) recently released a report that the government overpaid for over half of reviewed payment requests to Medicare for polysomnography services. Overall, the agency estimates the government overpaid by $269 million for these sleep study services.

How did the OIG come to this conclusion?

The agency reviewed Medicare claims for polysomnography services from January 2014 through December 2015. During this period the agency estimates CMS spent $800 million for polysomnography services. The payments went out to professionals who provided these services for 974,901 beneficiaries.

The OIG states the error was the result of a failure by CMS to properly oversee claims for these services. It states the CMS’ Medicare Administrative Contractors (MACs) need to periodically review claims for polysomnography services for those that do not meet Medicare requirements.  

What does this new report mean?

As a result of this report, the OIG has made the following recommendations:

  • Recover overpayments. The OIG recommended Medicare request repayment from providers. The agency has asked the Centers for Medicare and Medicaid Services (CMS) to have their MACs review claims over the allowed 4-year look back period and recover any overpayments.
  • Conduct reviews. The agency also recommends the CMS use MACs to conduct regular reviews of these claims to reduce the risk of additional overpayments in the future.
  • Educate providers. The OIG study also encourages the CMS to teach providers proper billing techniques for polysomnography services.

The CMS agreed with the recommendations. This will likely lead to an increase in demands for overpayment from Medicare. Those who receive such a demand can appeal the request. An attorney experienced in the process can review the demand and discuss your options.

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