Federal Reports

International Institute of Sleep, Inc. (the Institute), an Independent Diagnostic Testing Facility based in Deerfield Beach, Florida, billed Medicare for polysomnography services that did not meet Medicare billing requirements for all 100 randomly selected beneficiaries with 130 corresponding lines of service, resulting in overpayments of $78,000. These errors occurred primarily because the Institute did not have adequate controls to ensure that it properly documented polysomnography services billed to Medicare. On the basis of our sample results, we estimated that the Institute received overpayments of at least $1 million for the audit period.

Since the Part D program went into effect in 2006, the Office of Inspector General (OIG) has had ongoing concerns about abuse and diversion of Part D drugs. In June 2015, OIG released a data brief, Questionable Billing and Geographic Hotspots Point to Potential Fraud and Abuse in Medicare Part D, which described trends in Part D spending and identified questionable billing by pharmacies. This data brief builds on that body of work. It updates information on spending for commonly abused opioids and provides data on the dramatic growth in spending for compounded drugs.

During a prior review of a Medicaid-funded mental health program in New York State (the State), we observed that some providers were paid more than the Medicaid base rate for certain services. These providers participated in the State's Comprehensive Outpatient Program Services (COPS) and Community Support Program (CSP) programs and, as program participants, received supplemental (add-on) payments subject to annual payment thresholds in exchange for offering "enhanced services" to Medicaid beneficiaries. We decided to review these add-on payments and other aspects of the State's COPS and CSP programs.