On the OIG’s Radar
Top Services and Billing Codes Targeted for Fraud, Waste, and Abuse
The Office of Inspector General (OIG) plays a critical role in overseeing and maintaining the integrity of the nation’s health care system. Given the vast sums of money in play, healthcare is often a target for fraudulent activities. Staying updated with the OIG’s focus can help medical practitioners stay compliant and maintain best practices. In this blog post, we delve into the top services and billing codes that have recently caught the OIG’s attention for potential fraud, waste, and abuse.
1. Home Health Services:
Billing Codes: HCPCS codes G0179, G0180, G0181, and G0299.
Why on the radar? Home health services can be easy targets due to the off-site nature of care, making verification challenging. The OIG has identified irregularities like billing for patients who aren’t homebound and billing for unnecessary services or services not rendered.
2. Durable Medical Equipment (DME):
Billing Codes: A wide range, but common ones include E1390, E0601, and K0823.
Why on the radar? DME billing has a history of inflated charges, equipment not delivered, or providing more expensive equipment than required.
3. Psychotherapy Services:
Billing Codes: CPT codes 90834, 90837, and the associated add-on codes.
Why on the radar? Overbilling, billing for sessions that didn’t occur, or instances where the duration of therapy was exaggerated have been observed.
4. Chiropractic Services:
Billing Codes: CPT codes 98940, 98941, 98942.
Why on the radar? While chiropractic services can be beneficial, billing for medically unnecessary services or maintenance therapy beyond the initial treatment phase has raised flags.
5. Physical Therapy:
Billing Codes: CPT codes 97110, 97112, 97116, among others.
Why on the radar? Instances of billing for services without a valid order, provision by unqualified personnel, or billing for more expensive services than those rendered are common concerns.
6. Compound Medications:
Billing Codes: Varies depending on the drug, but often under Part D.
Why on the radar? There’s growing concern around the medical necessity of some compound prescriptions, especially when they are significantly more expensive than standard medications.
7. Ambulance Services:
Billing Codes: A0425, A0426, A0427, A0428, etc.
Why on the radar? Billing for unnecessary trips, especially non-emergency transport when not required, has been a point of contention.
Conclusion:
The OIG’s focus is all about ensuring that the medical billing landscape is as transparent, honest, and patient-centric as possible. By keeping a close eye on these services and billing codes, providers can better position themselves to avoid scrutiny and ensure they are delivering the highest level of care. Regular audits, proper documentation, and continuous training can help providers stay compliant and off the OIG’s radar. Remember, it’s not just about avoiding fines; it’s about upholding the trust and health of the patients we serve.