The HHS Office of the Inspector General has just completed an analysis of ultrasound claims from 2007, and found what looks like a lot of suspicious activity, especially in 20 U.S. counties which account for far more than their share of ultrasound claims. Based on these results, HHS may begin taking steps to revoke a provider's Medicare number if too many signs of ultrasound fraud (below) show up.
Those 20 counties got 16 percent of Medicare spending for ultrasounds, despite having 6 percent of the country's medicare beneficiaries, according to Inspector General Daniel Levinson. What's more, those 20 countries were in the top 1 percent of counties nationwide for both average allowed charges for ultrasound per Medicare beneficiary and percentage of beneficiaries getting ultrasound services.
The analysis found that there were five characteristics that distinguished potentially fraudulent ultrasound claims from legitimate ones, including that there was no prior service claim, such as an office visit, from the doctor ordering the scan; billing for combinations of ultrasound services that were duplicative or not effective in adults; claims for more than five ultrasounds for the same beneficiary on the same day for the same provider; bills for ultrasounds for more than five providers for a single beneficiary, in a single year, which suggested misuse of a Medicare number; and missing or invalid data in fields identifying the doctor ordering the service.
To learn more about the report:
- read this Health Leaders Media piece