OIG implements prepayment review

The OIG is using a new tool to prevent fraud, waste and abuse.

The Provider Field Investigations Unit recently implemented a prepayment review for a Pasadena, Texas provider who had been billing for allergy testing services that appeared to potentially indicate over testing or inadequate testing. Prepayment review is a fraud, waste and abuse prevention tool that requires a provider to submit claims and supporting documentation before receiving payment for claims billed. This is the first prepayment review implemented by the OIG under a recently-updated OIG policy, and is expected to be a useful safeguard against the delivery of unnecessary services, to monitor quality of services provided and to ensure payments are appropriate. Since the prepayment review went into effect in April of 2019, the providers’ billings and payments decreased significantly. In the three months prior to the placement of the prepayment review, encounter data reflects that the provider had been paid approximately $61,000. Since implementation, the payments decreased to under $1,000. 

You can read more about the OIG’s work in the latest Quarterly Report: tinyurl.com/TxOIGQRs