tci Medicare Compliance & Reimbursement - 2004 Issue 8

Labs: OIG Eyes State Lab Payment Policies

Audit could affect lab payments.The HHS Office of Inspector General says the state of Massachusetts overcharged the federal government $4.1 million.After reviewing the state's Medicaid laboratory billing system, the watchdog agency determined that the state's Medicaid payments for hospital outpatient and pathology tests exceeded the rates allowed by the Medicare program, a disparity that violates The Social Security Act.The analysis, titled "Review of Claims Paid for Clinical Diagnostic Laboratory Services Under the Massachusetts Revised Fee Schedule" (A-01-02-00015), showed that of the $29 million in hospital outpatient laboratory claims submitted by the State for the period...

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