GOV’T AUDIT INSIDER: Improper Medicare billing in California
Healthcare Auditing Weekly, August 23, 2005
Contrary to Medicare guidelines, Lake Forest, CA-based Garfield Imaging Center billed Medicare for diagnostic services ordered by chiropractors for calendar years 2001, 2002, and 2003 resulting in $88,747 in Medicare overpayments, according to an OIG audit report. According to the report, Garfield Imaging did not have adequate controls to prevent billing Medicare for diagnostic services ordered by chiropractors.
The OIG recommends that Garfield Imaging refund the $88,747 and strengthen controls to ensure that it does not bill Medicare for diagnostic services ordered by chiropractors.
During the audit, the OIG did the following:
- Reviewed applicable federal criteria and state laws and regulations
- Extracted the CMS claims history file all of Garfield Imaging's applicable claims
- Verified the specialty of each ordering physician and identified those who were chiropractors
- Interviewed Garfield Imaging representatives about the claims for services ordered by chiropractors
- Discussed the results of our audit with Garfield Imaging Officials
Click here to read the audit report, "Review of Services Ordered by Chiropractors and Performed by Garfield Imaging Center," (A-09-05-00055) issued July 11.
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