Providers say Medicare audit losses overstated
June 1, 1998 2 minutes read
Providers say Medicare audit losses overstated
Report raises fear of regulatory retaliation
The Washington, DC-based American Society of Internal Medicine (ASIM) has raised a number of concerns about the reliability of the recent financial audit of Medicare payments - along with fears about the resulting regulatory fallout prompted by its findings. (See related story on p. 94 for more details on the audit.)
Among ASIM's specific concerns were the following items:
· Statistical validity of the estimates. Auditors only reviewed 8,048 of the 853 million claims submitted to Medicare last year - less than one one-thousandth of 1% of Medicare claims, says ASIM. The Office of Inspector General (OIG) acknowledges its estimate of fraud, waste, or coding error in Medicare fee for service could be off by as much as plus or minus 40%. "This raises significant questions about the reliability of the OIG's estimates of improper claims," says ASIM president Alan R. Nelson, MD.
· Significance of documentation problems. Inadequate documentation in medical records, the largest category of claims that were allegedly paid to physicians in error, does not indicate that fraud or abuse has occurred, argues ASIM. Even HCFA administrator Nancy-Ann Min DeParle has acknowledged, "Many of the erroneous payments were due to inadequate documentation, which is not synonymous with fraud and abuse."
Lack of documentation does not mean "improper" payments, ASIM says. "A physician may have billed for the right code and the right level, but simply did not provide the extensive documentation that the OIG's auditors believed to be appropriate," notes Nelson." In such instances, not only has no fraud and abuse occurred, no overpayment has occurred."
You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content