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Report (OEI-12-10-00190)

12-27-2011
Questionable Billing Patterns of Portable X-Ray Suppliers

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Summary

Twenty portable x-ray suppliers exhibited questionable billing patterns according to criteria we established. In addition, Medicare paid approximately $12.8 million for return trips to nursing facilities on a single day and, contrary to Federal regulations, Medicare paid approximately $6.6 million for services ordered by nonphysicians (which are not covered).

Medicare paid approximately $225 million for x-rays of the extremities, pelvis, spine, skull, chest, and abdomen rendered in 2009 by portable x-ray suppliers. Portable x-ray suppliers are entities that furnish x-rays at a beneficiary's location using mobile diagnostic equipment. Medicare pays portable x-ray suppliers separately for the transportation and setup of the mobile equipment in addition to the administration of the test and interpretation of the results. Pursuant to Federal regulations, portable x-rays must be ordered by a licensed physician. We used 2008 and 2009 Medicare claims data, nursing home stay data, and provider enrollment data to examine portable x-ray suppliers' billing patterns and to identify individual claims that may warrant further review.

We identified 20 suppliers with billing patterns that met our criteria for questionable billing patterns. We also found that Medicare paid approximately $12.8 million for return trips to nursing facilities on a single day. Lastly, contrary to Federal regulations, Medicare paid approximately $6.6 million for services ordered by nonphysicians.

We recommend that CMS (1) take appropriate action on portable x-ray suppliers referred by OIG, (2) establish a process to periodically identify portable x-ray suppliers that merit greater scrutiny and follow up as appropriate, (3) determine what portion of the $12.8 million it paid for return trips in 2009 actually reimbursed suppliers for incorrectly billed transportation component claims and collect any overpayments, (4) collect the $6.6 million in overpayments it made for portable x-ray services rendered in 2009 that were ordered by nonphysicians, and (5) implement procedures to ensure that it pays for portable x-ray services only when they are ordered by a physician and establish appropriate controls. CMS concurred with our recommendations.

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