Federal investigators are recommending a moratorium on any new independent diagnostic testing facilities being certified (PDF) for Medicare participation in Los Angeles after a citywide inspection found more than one-third of the existing 132 facilities were not open during the day or not operating from listed addresses.
Testing-facility audits raise red flags
A parallel investigation in Miami (PDF) found that nearly a third of the 92 facilities there broke the same rules. Yet when the CMS moved to boot three noncompliant centers from participation, it took an average of 17 weeks to complete the paperwork—during which time Medicare approved another $146,000 in claims for the three.
Those were key findings in two audits released Tuesday on the historically fraud-prone sector of independent diagnostic testing facilities, a type of free-standing center allowed to perform tests like X-rays, magnetic resonance imaging, ultrasounds and sleep studies outside of traditional hospitals and physicians' offices.
Investigators personally visited each facility in the two cities last year. They turned up numerous instances of signs saying the locations were actually different businesses or facilities having no sign at all. Eleven of the Miami and Los Angeles addresses were for private residences, and seven facilities listed nonexistent street addresses.
The 73 noncompliant facilities between the two cities billed Medicare for a total of $8.8 million in 2010, including $4.1 million sent in after the inspection dates.
HHS' inspector general's office recommended CMS conduct periodic, unannounced site visits to check that facilities have accurate addresses on file and are operating during normal business hours. In response, CMS officials said they concurred with every recommendation except for the suggested moratorium on new Los Angeles facilities, saying they would take the advice “under strong consideration.”
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