OIG Finds Improper Medicare Emergency Billing

On Tuesday, the Department of Health and Human Services (HHS) Office of Inspector General (OIG) released the results of a report that found improper coding in emergency department procedure codes led to $15 million in improper or potentially improper payments.

The report covered emergency department codes for services provided in 2021 and 2022 to determine Medicare compliance for site-specific codes. Medicare only reimburses at emergency rates if the procedure is performed in the emergency department. It found that Medicare improperly paid for nearly 10,000 procedures totaling $922,524 due to physicians improperly billing for emergency department procedures with nonemergency place of service codes.

The report was unable to determine if the site was appropriate for another set of codes, and Medicare beneficiaries may have also paid Part B deductibles that were incorrectly charged by hospitals for up to $394,591 total.

OIG made five recommendations, including that the Centers for Medicare and Medicaid Services recoup the $922,524 in improper payments and to assess the $14.2 million in potentially improper payments to determine allowability and recoup improper payments. CMS confirmed that it will follow the first recommendation. Read the details from HHS OIG.