Good morning to all from Washington, DC. Today OIG posts a report and news about enforcement actions. As always, you can use the links provided to go directly to the new material. ------------------------------------------------------------------------------ Coverage and Payment for Genetic Laboratory Tests (OEI-07-11-00011) http://go.usa.gov/dJF Why We Did This Study OIG is currently conducting an evaluation entitled Payments for Laboratory Tests: Comparing Medicare, State Medicaid, and Federal Employees Health Benefits Programs (OEI-07-11-00010). The objectives of that evaluation are to determine: (1) How the methods for establishing Medicare laboratory test payment rates vary from State Medicaid and Federal Employee Health Benefits (FEHB) programs, and (2) The extent to which 2011 Medicare payment rates for 20 high volume and/or high expenditure laboratory tests vary from State Medicaid and FEHB plans. During a meeting on June 29, 2011, CMS officials informed us that, in addition to high volume and high expenditure laboratory tests, a collection of pricing data for genetic tests from other health care insurers would assist CMS in establishing payment rates for genetic tests. How We Did This Study We surveyed State Medicaid and FEHB plan staff and interviewed Veterans Health Administration staff about their coverage policy and establishment of payment rates, and obtained 2011 payment rates for selected genetic tests by name and by Common Procedural Terminology code from each of the health care insurers we surveyed. What We Concluded In our memorandum report, we present information provided to us through surveys and interviews in the areas of coverage policies, payment methods, and payment rates for genetic tests. We have provided this information for CMS’s use in setting Medicare coverage and payment policies for genetic tests. Because State Medicaid programs and private health insurance plans closely monitor Medicare’s coverage and reimbursement decisions, CMS’s formulation of reimbursement rates for genetic tests may be useful to them. ------------------------------------------------------------------------------ June 12, 2012; U.S. Attorney; Eastern District of Pennsylvania Founder of Mental Health Clinic Convicted of Health Care Fraud http://go.usa.gov/yWn ------------------------------------------------------------------------------ June 12, 2012; U.S. Attorney; Southern District of Florida Miami-Area Resident Sentenced to 46 Months in Prison for Participating in Medicare Fraud Scheme http://go.usa.gov/yWn ------------------------------------------------------------------------------ June 12, 2012; U.S. Attorney; Eastern District of Virginia Richmond Marketing Company Owner Sentenced to 37 Months for Conspiring to Receive Health Care Kickbacks http://go.usa.gov/yWn ------------------------------------------------------------------------------ That’s all we have for today. If we can be of any further assistance, please send an Email to public.affairs@oig.hhs.gov I hope your week is going well. Marc Wolfson – Office of External Affairs OIG’s privacy policy can be found at http://oig.hhs.gov/notices/privacy-notice.asp
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OIG Posts a Report and News about Enforcement Actions - 6/13
