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Report File
Date Issued
Submitting OIG
Department of Health & Human Services OIG
Other Participating OIGs
Department of Health & Human Services OIG
Agencies Reviewed/Investigated
Department of Health & Human Services
Components
Centers for Medicare and Medicaid Services
Report Number
A-09-21-03016
Report Type
Audit
Number of Recommendations
4
Questioned Costs
$4,663
Funds for Better Use
$8,844,899
External Entity
Noridian Healthcare Solutions, LLC

Open Recommendations

This report has 4 open recommendations.
Recommendation Number Significant Recommendation Recommended Questioned Costs Recommended Funds for Better Use Additional Details
23-A-09-086.04 No $0 $8,844,899

We recommend that Noridian Healthcare Solutions, LLC update the educational material on its website as well as any previously provided webinars to include all Medicare requirements and guidance for billing and documenting ESRD-related services and continue to perform medical record reviews as part of the TPE program, which could have saved the Medicare program an estimated $8,844,899 and could have saved Medicare enrollees up to an estimated $2,204,799 for our audit period.

23-A-09-086.02 No $0 $0

We recommend that Noridian Healthcare Solutions, LLC notify the physicians and qualified nonphysician practitioners to refund $1,162 in coinsurance that was collected for the 26 sampled enrollee-months.

23-A-09-086.03 No $0 $0

We recommend that Noridian Healthcare Solutions, LLC based on the results of this audit, notify appropriate physicians and qualified nonphysician practitioners (i.e., those for whom Noridian determines this audit constitutes credible information of potential overpayments) so that the physicians and practitioners 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-09-086.01 No $4,663 $0

We recommend that Noridian Healthcare Solutions, LLC recover $4,663 in improper payments made to physicians and qualified nonphysician practitioners for the 26 sampled enrollee-months.

Department of Health & Human Services OIG

United States