Mobile imaging services provider Precision Health of Staten Island, NY, improperly claimed at least $332,000 in Medicare reimbursement for unallowable portable x-ray services, according to an investigation by the U.S. Office of Inspector General (OIG).
After determining that Precision Health ranked among the highest-paid service providers of portable x-ray services in New York and New Jersey, the OIG reviewed claims for portable x-ray services to assess whether or not they complied with Medicare Part B requirements. The review encompassed Precision's Medicare reimbursement claims for portable x-ray services between January 1, 2011, and October 31, 2012, a period for which Precision received nearly $7.9 million in Medicare reimbursement.
The OIG reviewed a stratified sample of 117 claims during that period and found that 29 did not comply with certain Medicare requirements. As a result, the agency estimated that Precision improperly claimed at least $322,000 in Medicare reimbursement for unallowable portable x-ray services over the review period.
"These improper payments occurred because Precision did not have adequate procedures in place to ensure services were ordered by a physician, properly supervised, or that transportation costs were billed correctly," according to the OIG report. "Precision also did not maintain documentation that adequately supported the services for which it claimed Medicare reimbursement."
As a result, the OIG recommended that Precision refund $120,628 for portable x-ray services that are within the three-year claim recovery period, work with the Medicare Administrative Contractors to return the remaining overpayments outside of the three-year claim recovery period, and strengthen its procedures to ensure that it complies with Medicare requirements.
Precision is disputing multiple aspects of the findings, including the determinations for 21 of the claims and that the number of claims it agreed were in error did not support OIG's extrapolation of the amount of improper Medicare payments. It furthermore believes it does not have any repayment obligation for the remaining claims because they complied with Medicare coverage conditions for portable x-ray services and, therefore, are not subject to the 60-day repayment rule, according to the report.
The U.S. Centers for Medicare and Medicaid Services "will make the final determination as to the total amount to be refunded and will work with Precision to determine whether it may have liability under the 60-day repayment rule," the OIG report said.
