Daniel Levinson, inspector general at the Department of Health & Human Services (HHS; Washington) informed the Center for Medicare & Medicaid Services this past June 30 that an HHS audit of claims filed by independent diagnostic testing facilities (IDTFs) for calendar 2001 disclosed "a marked pattern of repetitive use of services." Levinson said the analysis suggested that IDTFs "enrolled with 10 selected carriers received $71.5 million in Medicare payments … for services that did not comply with federal law, regulations and guidelines."

Levinson's memo to CMS Administrator Mark McClellan stated that providers for 80 of the 230 beneficiaries whose records were reviewed "received 1,231 services that did not comply" with regulations and that the 94 IDTFs involved took in nearly $165,000 for those services. These numbers were apparently extrapolated to the entire Medicare program to arrive at the figure of $71.5 million cited above.

The violations cited by Levinson's office include failure to "always comply with initial enrollment application and subsequent update requirements" and failure to report "operational changes such as the identity and number of technicians, supervising and interpreting physicians, type and model number of equipment, and tests performed." Changes of location and ownership also made the list of violations uncovered in the audit.

A pie chart in the report disclosed that of the $165,000 cited in the audits, more than $75,000 was for 546 services deemed not reasonable or unnecessary. Insufficient documentation plagued 544 services which came to almost $70,000, and 102 services were performed but not ordered to the tune of more than $12,000.

The Office of Inspector General recommended that CMS go after the identified overpayments and perform further audits to recover additional monies. Levinson's memo also recommended that CMS "consider performing site visits to monitor compliance."

According to Levinson, CMS agreed to pursue the overpayments provided that doing so would not cost more than the amounts that would be recovered. However, CMS apparently will not perform site visits due to budgetary considerations.

— Mark McCarty, Washington Editor