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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
Report Number
A-06-16-02002
Report Description

Professional Clinical Laboratory, Inc. (ProLab) generally did not comply with Medicare requirements for billing travel allowances. Specifically, of the 100 travel allowance claim lines in our stratified random sample, 35 claim lines complied with Medicare requirements and 65 claim lines did not (some lines had multiple deficiencies). ProLab did not (1) support prorated miles with documentation when multiple patients were served on a single trip, (2) resubmit claims when there was a retroactive change in the clinical laboratory fee schedule, and (3) have documentation to support specimen collections.

Report Type
Audit
Number of Recommendations
3
Questioned Costs
$319,277
Funds for Better Use
$0
Additional Details
https://oig.hhs.gov/oas/reports/region6/61602002.asp
External Entity
Professional Clinical Laboratory, Inc.

Open Recommendations

This report has 3 open recommendations.
Recommendation Number Significant Recommendation Recommended Questioned Costs Recommended Funds for Better Use Additional Details
265883 No $0 $0

We recommend that ProLab, for the remaining portion of the estimated $319,277 overpayment for claims that are outside of the Medicare reopening period, exercise reasonable diligence to identify and return overpayments in accordance with the 60-day rule, and identify any returned overpayments as having been made in accordance with this recommendation.

265882 No $319,277 $0

We recommend that ProLab refund to the Medicare program the portion of the estimated $319,277 overpayment for claims incorrectly billed that are within the reopening period.

265884 No $0 $0

We recommend that ProLab exercise reasonable diligence to identify and return any additional similar overpayments outside of our audit period, in accordance with the 60-day rule, and identify any returned overpayments as having been made in accordance with this recommendation.

Department of Health & Human Services OIG

United States