Audit Points To Hospital Overbilling For Procedure

Aug 21, 2018

Hospitals nationwide overbilled the Medicare program as much as $25.8 million for providing patients an advanced type of radiation procedure used to treat difficult-to-reach tumors on an outpatient basis.

The procedure, known as intensity-modulated radiation therapy, is provided in two treatment phases: planning and delivery. The audit, conducted by the U.S. Department of Health and Human Services’ Office of the Inspector General, shows that Medicare paid hospitals $109.2 million between 2013 and 2015 to cover both phases of the radiation therapy but that hospitals erroneously billed Medicare up to $25.8 million for the planning phase.

“The overpayments primarily occurred because the hospitals appeared to be unfamiliar with or misinterpreted the Centers for Medicare & Medicaid Services (CMS) guidance,” the audit said.

Auditors reviewed a random sample of 100 line items on hospital bills containing reference to complex therapy, representing payments of $21,390 to 91 hospitals.

“For all 100 line items in our sample, the hospitals separately billed for complex simulations when they were performed as part of IMRT planning,” the report said. Based on those findings, auditors estimated that Medicare overpaid as much as $25.8 million.