Medicare contractors may have significantly overpaid for intensity-modulated radiation therapy services, according to a new report from the U.S. Dept. of Health and Human Services’ Office of the Inspector General.
In its report, the OIG said that it reviewed claims paid to hospitals from National Government Services, Inc., that contained specific IMRT services at risk for noncompliance with Medicare requirements. The office identified 25,9000 claims paid by NGS that contained “potentially unallowable IMRT services totaling $80.1 million.”
The federal watchdog estimates that Centers for Medicare and Medicaid Services overpaid “at least $5.7 million for unallowable IMRT services” in MAC jurisdictions 6 and K based on data from the audit of NGS.
The OIG added that it also sampled 100 random beneficiaries and submitted their associated services for independent medical review, and found that NGS maid overpayments for at least 1 service for 99 of the 100 beneficiaries.
Overpayments occurred due to system edits not preventing NGS payments to hospitals for incorrectly billed IMRT services and because hospitals were “unfamiliar with or misinterpreted Medicare guidance when billing for IMRT services, or cited clerical errors,” the OIG reports.
The OIG said it made three recommendations to NGS for recovering the overpayments it identified, and two procedural recommendations for payment edits and hospital education on IMRT billing.
Earlier this month, the OIG published a report claiming that the CMS overpaid medical device suppliers by $34 million.