OIG posts 3 reports and news about enforcement actions - 9/25

Good morning to all from Washington, DC. Today OIG posts three reports and news about enforcement actions. As always, you can use the links provided to go directly to the new material.   ------------------------------------------------------------------------------     Utilization of Medicare Ambulance Transports, 2002-2011 (OEI-09-12-00350) http://go.usa.gov/Dd6P   WHY WE DID THIS STUDY Since 2002, Medicare Part B payments for ambulance transports have grown at a faster rate than all Medicare Part B payments.  This increase in payments was caused in part by inflation and the transition to the national fee schedule for Medicare ambulance transports.  Continued growth in the utilization of transports has also contributed to the increase.  From 2002 to 2011, the number of Medicare ambulance transports increased 69 percent (from 8.7 million to 14.8 million).  In 2011, Medicare payments under Part B for ambulance transports totaled $5.7 billion.   HOW WE DID THIS STUDY We reviewed Medicare Part B claims for ambulance transports from 2002 to 2011 and the Medicare Part A and B claims that were associated with these transports.  We also reviewed enrollment data for all Medicare fee-for-service beneficiaries.  We determined the extent to which the utilization of ambulance transports changed from 2002 to 2011.  For each year, we analyzed the characteristics of beneficiaries, suppliers, and transports and calculated the percentage differences since 2002.  We also calculated the changes in utilization within each State.    WHAT WE FOUND From 2002 to 2011, the number of beneficiaries who received ambulance transports increased 34 percent, although the total number of Medicare fee‑for‑service beneficiaries increased just 7 percent.  The number of ambulance suppliers increased 26 percent.  In particular, the number of ambulance suppliers that primarily provided basic life support nonemergency transports nearly doubled from 2002 to 2011.  The number of dialysis‑related transports increased 269 percent.  Furthermore, beneficiaries with end stage renal disease, a condition that often requires dialysis treatment, used a growing and disproportionate amount of transports each year.  Transports to and from hospitals increased at a significantly slower rate from 2002 to 2011 than did dialysis‑related transports, but represented a larger proportion of all transports.  Although all States experienced increases in transports from 2002 to 2011, utilization changes varied widely by State.    This report does not contain recommendations.   ------------------------------------------------------------------------------     Medicare Incorrectly Paid Hospitals for Beneficiaries Who Had Not Received 96 or More Hours of Mechanical Ventilation (A-09-12-02066) http://go.usa.gov/Dd6G   For inpatient claims with certain Medicare Severity Diagnosis-Related Groups (MS-DRGs), Medicare requires that beneficiaries have received 96 or more hours of mechanical ventilation.  For 14 of the 377 claims reviewed, Medicare payments to hospitals were correct.  However, for the 363 remaining claims, Medicare payments to hospitals were incorrect.  Specifically, the hospitals incorrectly used procedure code 96.72 when the beneficiaries had not received 96 or more hours of mechanical ventilation.  Consequently, the claims were assigned incorrectly to MS-DRGs 207 and 870, resulting in $7.7 million of overpayments.  The hospitals confirmed that these claims were incorrectly billed and generally attributed the errors to incorrectly counting the number of hours that beneficiaries had received mechanical ventilation or clerical errors in selecting the appropriate procedure code.  At the time of our audit, the Centers for Medicare & Medicaid Services (CMS) did not have controls to identify these erroneous claims.   We recommended that CMS:   (1) Ensure that the Medicare contractors recover the $7.7 million in identified overpayments and   (2) Direct the Medicare contractors to review any claims where procedure code 96.72 was used with a length of stay of 4 days or fewer and recover any overpayments after our audit period and before implementation of CMS’s new length-of-stay edit.    CMS partially concurred with our first recommendation and concurred with our second recommendation.  ------------------------------------------------------------------------------   Illinois Did Not Always Properly Claim Medicaid Reimbursement for Hospice Claims (A-05-12-00029) http://go.usa.gov/DdFd The Illinois Department of Healthcare and Family Services (State agency) did not always properly claim Federal Medicaid reimbursement for hospice claims.  For 23 of the 120 sampled claims, the State agency did not properly claim Federal Medicaid reimbursement.  However, the unallowable dollar amounts related to these 23 claims are immaterial.   ------------------------------------------------------------------------------   September 24, 2013; U.S. Attorney; Eastern District of Pennsylvania Doctor Sentenced for Running Pill Mill and Contributing to a Death http://go.usa.gov/DgZj      ------------------------------------------------------------------------------   September 24, 2013; U.S. Attorney; District of Kansas Hays Woman Pleads Guilty to Social Security, Medicaid Fraud http://go.usa.gov/DgZj     ------------------------------------------------------------------------------   State Enforcement Actions Updated http://go.usa.gov/DgZV   ------------------------------------------------------------------------------   That’s all we have for today. If we can be of any further assistance, please send an Email to public.affairs@oig.hhs.gov    I hope your week is going well.   Marc Wolfson – Office of External Affairs   OIG’s privacy policy can be found at http://oig.hhs.gov/notices/privacy-notice.asp Follow us on Twitter: http://twitter.com/OIGatHHS Inquiries? Contact us: Public.Affairs@oig.hhs.gov Manage your OIG subscriptions: update your preferences or unsubscribe Questions about this service? Support@GovDelivery.com This email was sent to buzzhairs.health@blogger.com using GovDelivery, on behalf of the U.S. Dept. of Health & Human Services · 200 Independence Avenue SW · Washington DC 20201 · 1-877-696-6775