The Office of the Inspector General (OIG), which is the investigative wing of the U.S. Department of Health and Human Services (HHS), released its Fiscal Year 2009 (FY09) Work Plan on October 1, 2008. The Work Plan details new and ongoing investigations for the period of October 1, 2008 through September 30, 2009. Two of the investigations that will be conducted focus specifically on Medicare billing for sleep-related services. These investigations are serious matters that are designed to detect fraud in and recover funds for the Medicare program. Please take note of the details provided below on scheduled OIG activity.
Appropriateness of Medicare Payments for Polysomnography
OIG will examine the appropriateness of Medicare payments for sleep studies. The OIG investigation will look specifically at the factors contributing to the rapid rise in Medicare reimbursements for sleep studies from $62 million in 2001 to $215 million in 2005. In the course of theses OIG audits, they will also assess overall compliance with federal program requirements, including whether medical records provide appropriate justification that supports claims for payment. When the OIG audits a practice they will examine claims for polysomnography AND other claims for patient care services.
Medicare Payments for CPAP Devices
OIG will undertake a review of the appropriateness of Medicare payments for CPAP devices. Specifically, OIG will examine records to determine whether Medicare payments for CPAP devices were supported, billed and paid in accordance with Medicare requirements. This investigation was triggered by previous OIG work that revealed cases where Medicare paid for CPAP devices that were not used by or delivered to beneficiaries.
Going Forward
It is certain that at least some AASM members will have their billing and medical records reviewed by OIG investigators. The serious nature of an OIG investigation cannot be understated: significant expenses, fines, and even criminal convictions are associated with these investigations. Please direct any questions related to the OIG investigations to Bruce Blehart bblehart@aasm.org or Nick Cekosh at ncekosh@aasm.org.
