Noridian Healthcare Solutions, LLC, Made Improper Medicare Payments of $4 Million to Physicians in Jurisdiction E for Spinal Facet-Joint Injections

Facet-joint injections of an anesthetic with or without a steroid are used to diagnose or treat chronic neck and back pain. A prior Office of Inspector General (OIG) review found that 47 percent of Medicare payments to physicians for facet-joint injections nationwide in calendar year (CY) 2006, or approximately $96 million, did not meet Medicare program requirements. In addition, Noridian Healthcare Solutions, LLC (Noridian), one of the Medicare Administrative Contractors (MACs), identified during audits performed in CYs 2016 through 2018 various errors in which physicians did not bill for facet-joint injections in accordance with Medicare requirements. Therefore, we conducted this audit to determine whether Noridian made improper payments for facet-joint injections in Jurisdiction E from January 1, 2018, through May 31, 2019 (audit period).