Provider Investigations reports second quarter results

The OIG's Provider Investigations unit (PI) completed 441 preliminary investigations and 53 full investigations in the second quarter of fiscal year 2022.

PI investigates and reviews allegations of fraud, waste and abuse involving Medicaid providers. Based on an investigation's findings, OIG actions can include education, prepayment review of claims, penalties, required repayment of Medicaid overpayments and/or exclusion from the Medicaid program.

A sample of case results for Provider Investigations settled by Litigation for the second quarter includes:

• In February, the OIG resolved two cases against a Cleveland physician providing electroencephalograms (EEGs) ─ a test that detects electrical activity in the brain. Between September 2014 and August 2018, the provider submitted claims for conducting EEGs but did not include the required documentation to support the claims. The provider worked collaboratively with OIG Litigation to resolve the issue, agreeing to pay $141,697 in restitution.
• The OIG settled a case in January against a Dallas-area hospital that improperly billed for injections and infusions administered by either a nurse or other hospital personnel in the emergency department. Injections and infusions are included in an emergency room charge and are not reimbursed separately. The provider worked collaboratively with OIG Litigation to resolve this issue, and the OIG agreed to a settlement of $104,381.
• The OIG settled cases in February against a Fort Worth home health agency. The provider submitted bills for and was paid for more than the maximum allowable amount (96 units or 24 hours/day) of private duty nursing per client. The provider worked collaboratively with OIG Litigation to resolve these issues, and the OIG agreed to a settlement of $95,918.