Medicare paid more than $19 million in claims for portable X-ray services in 2009 that auditors now say could have been fraudulent, based on patterns of past inappropriate activity, follow-up research and the fact that many of the offices were in Miami, a hotspot for Medicare fraud.
20 portable X-ray suppliers may have filed false claims
HHS Inspector General Daniel Levinson's office reviewed the suppliers of $225 million in Medicare portable X-ray services and came up with a list of eight criteria that indicated questionable activity, including services not ordered by physicians, bills for multiple trips to the same facility on the same day and claims for in-home services when the beneficiary traveled to a clinic on the same day.
The result was a list of 20 portable X-ray suppliers that deserve further scrutiny, 13 of which are in Miami, according to a report on the analysis.
The inspector general's office also concluded that the CMS should immediately recover $6.6 million in services ordered by nonphysicians in violation of federal law and closely examine $12.8 million in bills for repeat trips to nursing homes on the same day.
Medicare allows doctors to order in-home X-ray testing for beneficiaries who can't travel, even though only 20% of the $225 million spent on the service in 2009 went to actual test analysis. Federal officials say it's cheaper to pay the remaining 80% in transportation costs rather than having costly ambulances bring immobile beneficiaries to hospitals and clinics.
In an Aug. 4 response letter, then-CMS Administrator Dr. Donald Berwick concurred with the report's call for action to reclaim the $6.6 million in services not ordered by physicians. Berwick said it would not be cost-effective for the CMS to conduct a more detailed analysis of the $12.8 million in same-day trips, but that the agency's fraud contractors will be notified of the issue.
Berwick also noted that on June 30, the CMS launched its new Fraud Prevention System to examine every fee-for-service claim, including portable X-ray services, and will use the inspector general's report to help develop ways to analyze the X-ray bills.
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