OIG

OIG: Improve Medicare rate-setting for clinical diagnostic lab tests

April 12, 2024 - CMS’ procedures for setting Medicare rates for clinical diagnostic lab tests could improve for future public health emergencies, according to a new report from the Office of the Inspector General (OIG). OIG said in the report that, during the COVID-19 public health emergency, current Medicare rate-setting procedures “did not allow the...

Read More


More Articles

OIG: HRSA Made Improper Payments Through COVID-19 Uninsured Program

by Victoria Bailey

The Health Resources and Services Administration (HRSA) made improper COVID-19 Uninsured Program payments to providers that totaled an estimated $784 million, a report from the Office of Inspect...

OIG: Medicare Overpayments Due to Coding Discrepancies Totaled $22.5M

by Victoria Bailey

Medicare improperly paid practitioners at a higher non-facility rate for services provided to skilled nursing facility (SNF) or hospital inpatients, leading to over $22 million in overpayments, a...

OIG: Labs Billed Medicare Part B for High Levels of Diagnostic Tests

by Victoria Bailey

More than 370 labs submitted Medicare Part B claims that included questionably high billing for COVID-19 and additional diagnostic tests, a report from the Office of Inspector General (OIG)...

OIG: CMS System Edits Reduced Medicare Overpayments to Hospitals

by Victoria Bailey

CMS system edits helped reduce Medicare overpayments to acute care hospitals for outpatient services provided to beneficiaries who were inpatients of other facilities, a report from the Office of...

OIG: CMS Reported Collecting Only Half of Medicare Overpayments

by Victoria Bailey

CMS reported collecting only half of the $498 million in Medicare overpayments identified by the Office of Inspector General (OIG), according to an OIG audit. The OIG audit was a follow-up to a...

Federal Govt Received $1.9B from FY21 Healthcare Fraud Settlements

by Victoria Bailey

The federal government received almost $1.9 billion in healthcare fraud settlements and judgments in fiscal year 2021, according to a report from the HHS Office of Inspector General (OIG). The latest...

OIG: CMS Should Remove IPPS New Hospital Capital Cost Exemption

by Jill McKeon

A recent Office of Inspector General (OIG) audit recommended that CMS remove the inpatient prospective payment system (IPPS) new hospital capital cost exemption, which in recent years resulted in new...

OIG: Medicare Overpays for Chronic Care Management Services

by Jill McKeon

An Office of the Inspector General (OIG) audit discovered that Medicare consistently overpaid for chronic care management (CCM) services, incurring millions in costs for Medicare and its...

OIG: Do Not Charge, Balance Bill Patients for COVID-19 Vaccines

by Jacqueline LaPointe

Healthcare providers should not charge or balance bill patients for getting the COVID-19 vaccine, the Office of Inspector General (OIG) at HHS recently warned. In an April 15th message, the federal...

OIG Asks Hospital for $23.6M Back After Medicare Billing Errors

by Jacqueline LaPointe

The Office of the Inspector General has identified $23.6 million in overpayments reimbursed to a Nevada-based hospital, resulting from years of Medicare billing errors. In a report released on April...

Hospitals Increasingly Billing Inpatient Stays at Highest Severity

by Jacqueline LaPointe

A new report from the HHS Office of the Inspector General (OIG) has shown that hospitals have increasingly billed inpatient stays at the highest severity level, causing concern about Medicare...

OIG: Direct Wage Index Increases to Low-Margin Rural Hospitals

by Jacqueline LaPointe

Rural hospitals struggling the most financially are not benefitting from a Medicare reimbursement adjustment meant to help providers paying the lowest wages to their employees, according to a new...

OIG to Audit Medicare Payments for COVID-19 Discharges

by Jacqueline LaPointe

HHS’ Office of the Inspector General (OIG) will audit Medicare payments made to hospitals for COVID-19 discharges that qualified for a 20 percent add-on payment under the Coronavirus Aid, Relief,...

Hospitals Can Sell Patient Bad Debt to Charitable Orgs, OIG Says

by Jacqueline LaPointe

Charitable organizations like RIP Medical Debt can purchase patient bad debt directly from hospitals and other providers, according to a recent advisory opinion from HHS’ Office of the Inspector...

Medical Billing Mistakes for Malnutrition Led to $1B in Overpayments

by Jacqueline LaPointe

CMS should recoup the portion of nearly $1 billion that was incorrectly paid to hospitals because of medical billing and coding errors involving severe malnutrition diagnosis codes, HHS’ Office...

OIG Recovered Over $1.5B From Healthcare Fraud Schemes, So Far

by Jacqueline LaPointe

The Office of the Inspector General (OIG) at HHS expects to return over $1.5 billion to the federal government from healthcare fraud schemes investigated during the first half of the fiscal year,...

OIG to Audit $50B in Coronavirus Relief Funds Given to Providers

by Jacqueline LaPointe

The Office of the Inspector General (OIG) at HHS recently announced that it will audit the distribution of $50 billion in coronavirus relief funds to hospitals and other eligible healthcare...

AHA: Anti-Kickback Changes Too Narrow to Promote Value-Based Care

by Samantha McGrail

HHS’ Office of Inspector General (OIG) is taking steps toward “much needed reform” of Medicare fraud laws, but more can be done to remove the value-based care barriers presented by...

OIG Suggests Lowering Medicare Reimbursement for More Part B Drugs

by Jacqueline LaPointe

CMS could have saved an additional $2.9 million in 2017 if the agency lowered Medicare reimbursement for more Part B drugs through price substitution, the HHS Office of the Inspector General (OIG)...

Recent Articles