- Center on Health Equity & Access
- Clinical
- Health Care Cost
- Health Care Delivery
- Insurance
- Policy
- Technology
- Value-Based Care
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
Trump Administration’s Message to Supreme Court Puts New Wrinkle in Braidwood Case
February 21st 2025The Trump administration argues that HHS Secretary Robert F. Kennedy Jr can overrule the US Preventive Services Task Force to determine the preventive services covered under the Affordable Care Act.
Read More
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.
Listen
5 Key Health Care Moments During President Trump's First Month Back in Office
February 21st 2025President Donald J. Trump pushed for significant health care changes during his first month back in office, through executive orders affecting managed care, drug pricing, and clinical trial diversity guidance.
Read More
Same-Day Breast Imaging Gaps Reveal Health Care Disparities
February 18th 2025For this retrospective study, the authors examined data on more than 3 million screening mammographies for more than 1 million female patients; of the screenings, 23.6% had abnormal results and only 6.7% were recommended for biopsy.
Read More
