Medicare Payments to Providers for Polysomnography Services Did Not Always Meet Medicare Billing Requirements

From January 1, 2014, through December 31, 2015, Medicare administrative contractors (MACs) nation-wide paid freestanding facilities, facilities affiliated with hospitals, and physicians (collectively referred to as "providers") approximately $800 million for selected polysomnography (a type of sleep study to diagnose and evaluate sleep disorders) services. Previous OIG reviews for polysomnography services found that Medicare paid for services that did not meet Medicare requirements. These reviews identified payments for services with inappropriate diagnosis codes, without the required supporting documentation, and to providers that exhibited patterns of questionable billing.