Corporate Compliance

Improper payments for lab services found in eight of 11 states

Healthcare Auditing Weekly, April 21, 2009

Eight of 11 selected states made a combined $3.1 million in potentially improper payments for clinical diagnostic laboratory services provided on an assignment-related basis to dual eligibles in fiscal years 2005 and 2006, an OIG audit found.
 
Dual eligibles are beneficiaries enrolled in Medicare Part A and/or Part B who are also entitled to some Medicaid benefits. State Medicaid programs should not pay for outpatient clinical diagnostic laboratory services provided on an assignment-related basis to dual eligibles enrolled in Medicare Part B.
 
More than half of the potentially improper payments were related to five CPT codes. One of those codes accounted for almost 30% of the potential overpayments.
 
The OIG did not offer any recommendations in its audit report.

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