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Medicare Overpaid Docs Billions for Office Visits, OIG Says
Medicare overpaid physicians $6.7 billion in 2010 for evaluation and management services, HHS' Office of Inspector General said in a study released Thursday.
Medicare overpaid physicians $6.7 billion in 2010 for evaluation and management services, HHS' Office of Inspector General said in a study released Thursday. The overpayments, which allegedly stemmed from incorrect coding and poor documentation, accounted for more than one-fifth of the $32.3 billion the CMS paid for E/M services that year. E/M services are basic patient health assessments performed at a physician's office or clinic.
In a podcast, OIG officials Dwayne Grant and Rachel Bessette said they conducted the most recent study based on preliminary findings from 2012. In that report, the government found E/M services are “vulnerable to fraud and abuse” and that upcoding—billing Medicare for visits at higher, more expensive levels than they should've been—was rampant from 2001 to 2010. However, the agency was not able to discern if those E/M payments from its initial 2012 study were inappropriate.
Read the full story here: http://bit.ly/1wyMQds
Source: Modern Healthcare
What's at Stake as Oral Arguments Are Presented in the Braidwood Case? Q&A With Richard Hughes IV
April 21st 2025Richard Hughes IV, JD, MPH, spoke about the upcoming oral arguments to be presented to the Supreme Court regarding the Braidwood case, which would determine how preventive services are guaranteed insurance coverage.
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Varied Access: The Pharmacogenetic Testing Coverage Divide
February 18th 2025On this episode of Managed Care Cast, we speak with the author of a study published in the February 2025 issue of The American Journal of Managed Care® to uncover significant differences in coverage decisions for pharmacogenetic tests across major US health insurers.
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Comparing Breast Cancer Treatment Outcomes Between Fee-for-Service and Medicare Advantage
April 4th 2025This study examined postdiagnosis breast cancer treatment outcomes for Medicare Advantage vs fee-for-service (FFS) Medicare in Ohio and found no significant differences overall but disparities for Black patients with FFS Medicare.
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