A new report (OEI-12-10-00190) entitled Questionable Billing Patterns of Portable X-Ray Suppliers was issued by the Department of Health and Human Services, Office of the Inspector General (“OIG”). The report concluded that twenty portable x-ray suppliers exhibited questionable billing patterns. The study was conducted as part of the Health Care Fraud Prevention and Enforcement Action Team (“HEAT”) initiative, and is another prime example of the increased scrutiny facing health care providers.
Portable x-ray suppliers provide diagnostic imaging services to patients at a variety of locations, including nursing homes and private residences, as opposed to more traditional service locations, such as hospitals. Medicare pays portable x-ray suppliers for up to four components of the service: (1) transporting the equipment; (2) setting up the equipment for use; (3) administering the service; and (4) interpreting the results.
The report was conducted using Medicare claims data for imaging services provided in 2008 and 2009. In the report, the OIG concluded that Medicare paid approximately $225 million for all portable x-ray services in 2009. Of this amount, only 20% was for administering the x-rays and interpreting the results, while 80% was for transferring the equipment to the beneficiary’s location and setting it up for use.
Eight characteristics were developed to describe questionable billing patterns: (1) portable x-ray services ordered by non-physicians; (2) no recent contact between beneficiary and ordering provider; (3) same-day services in multiple settings; (4) billing for return trips to the same facility; (5) the number of portable x-rays billed by suppliers; (6) beneficiary contact with multiple portable suppliers; (7) beneficiary use of both stationary and portable x-rays; and (8) beneficiary DME utilization. Suppliers were determined to exhibit questionable billing patterns when they exceeded established thresholds in at least two of the above categories.
In addition to finding twenty suppliers that exhibited questionable billing patterns, the report identified $6.6 million for portable x-ray services that were ordered by non-physicians (and therefore not properly payable), and $12.8 million for return trips to nursing homes in a single day, which is often indicative of fraudulent or erroneous billing.
As a result, the OIG recommended that CMS take immediate action to recoup the $6.6 million in improper payments, and establish a process to more closely monitor portable x-ray suppliers. CMS agreed to take such action, and also indicated that it will share the results of the OIG report with Medicare Administrative Contractors and Recovery Audit Contractors for further investigation.
Portable X-ray suppliers, skilled nursing facilities and physicians who order portable radiologic services can expect significant increased scrutiny of these services in the future.
Get a Copy of the Report Here —> OIG Report