Medicare Improperly Paid Physicians for Epidural Steroid Injection Sessions

Submitting OIG:

Department of Health & Human Services OIG

Date Issued:

Friday, March 10, 2023

Agency Reviewed / Investigated:

Department of Health & Human Services

Submitting OIG-Specific Report Number:

A-07-21-00618

Component, if applicable:

Centers for Medicare & Medicaid Services

Centers for Medicare and Medicaid Services

Location(s):

Moldova

Type of Report:

Audit

Questioned Costs:

$121,189,991

Funds for Better Use:

Number of Recommendations:

View Document:

Attachment	Size
72003243.pdf	1.66 MB

Recommendation Number	Recommendation Status	Significant Recommendation
23-A-07-053.01	Open	No
We recommend that the Centers for Medicare and Medicaid Services direct the MACs to recover the $3,585,422 in improper payments made to physicians for epidural steroid injection sessions.
23-A-07-053.02	Open	No
We recommend that the Centers for Medicare and Medicaid Services instruct the MACs to, based on the results of this audit, notify appropriate physicians (i.e. those for whom CMS determines this audit constitutes credible information of potential overpauments) so that the physicians 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.
23-A-07-053.04	Open	No
We recommended that Centers for Medicare and Medicaid Services direct the MACs (or other CMS-designated entities) to review a sample of claims for epidural steroid injection sessions administered during the period beginning on January 1, 2021, and ending on the date that the revised coverage limitations (i.e., up to four sessions per 12-month period) became effective in the relevant MAC's jurisdiction (I.e. December 5, 2021, and June 19, 2022), to identify instances in which Medicare paid physicians for injection sessions that exceeded the number of allowable sessions (in accordance with the applicable LCDs) and recover any improper payments identified.

Recommendation Number

Recommendation Status

Significant Recommendation

Additional Details

23-A-07-053.01

Open

We recommend that the Centers for Medicare and Medicaid Services direct the MACs to recover the $3,585,422 in improper payments made to physicians for epidural steroid injection sessions.

23-A-07-053.02

Open

We recommend that the Centers for Medicare and Medicaid Services instruct the MACs to, based on the results of this audit, notify appropriate physicians (i.e. those for whom CMS determines this audit constitutes credible information of potential overpauments) so that the physicians 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.

23-A-07-053.04

Open