tci Medicare Compliance & Reimbursement - 2015 Issue 12

Compliance: Overbill And Risk Paybacks Down The Road

If your reimbursement seems too good to be true, it probably is. Two providers that were recently audited by the HHS Office of the Inspector General (OIG) didn’t seem to notice that they were paid more than double the reimbursement that they should have collected. However, you can rest assured the government will certainly notice the mistake if you overbill in your HCPCS code assignments. The case: The OIG launched an audit of aflibercept, a drug used to treat patients with age-related macular degeneration, and found that CGS Medicare paid $6 million for 1,414 line items for...

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