Where To Report Waste

Fraud, Abuse, Or Retaliation

Medicare Could Have Saved up to $216 Million Over 5 Years if Program Safeguards Had Prevented At-Risk Payments for Definitive Drug Testing Services

Submitting OIG:

Department of Health & Human Services OIG

Date Issued:

Monday, February 27, 2023

Agency Reviewed / Investigated:

Department of Health & Human Services

Submitting OIG-Specific Report Number:

A-09-21-03006

Component, if applicable:

Centers for Medicare & Medicaid Services

Centers for Medicare and Medicaid Services

Location(s):

United States

Type of Report:

Audit

Questioned Costs:

$105,951,927

Funds for Better Use:

$0

Number of Recommendations:

3

View Document:

Attachment	Size
92003033.pdf	2.89 MB

Related Open Recommendations

Recommendation Number	Recommendation Status	Significant Recommendation	Additional Details
23-A-09-045.01	Open	No
We recommend that the Centers for Medicare & Medicaid Services expand program safeguards to prevent and detect at-risk payments to at-risk providers for the definitive drug testing service with the highest reimbursement amount (procedure code G0483), which could have saved up to $215.8 million for our audit period.
23-A-09-045.02	Open	No
We recommend that the Centers for Medicare & Medicaid Services review at-risk payments made to at-risk providers during and after our audit period to determine whether payments for procedure code G0483 complied with Medicare requirements and recover any overpayments.
23-A-09-045.03	Open	No
We recommend that the Centers for Medicare & Medicaid Services notify appropriate providers (i.e., those for whom CMS determines this audit constitutes credible information of potential overpayments) so that the providers can exercise reasonable diligence to identify, report, and return any overpayments in accordance with the 60-day rule and identify any of those returned overpayments as having been made in accordance with this recommendation.